Subscribe to RSS
DOI: 10.1055/s-0040-1714659
Brain Arteriovenous Malformations: Impact of Neurologic Status, Bleeding, and Type of Treatment on Final Outcome
Abstract
Background Well-designed studies assessing the treatment outcome of brain arteriovenous malformations (AVMs) are infrequent and have not consistently included all of the available treatment modalities, making their results not completely generalizable. Moreover, the predictors of poor outcome are not well defined.
Methods We performed an observational retrospective study of AVM patients. We included patients with clinical, radiologic, and outcome data, with a minimum follow-up of 1 year. Neurologic outcome was documented using the modified Rankin Scale (mRS) at the AVM diagnosis and 30 days after the treatment.
Results There were 117 patients, with equal male/female proportion. The mean follow-up time was 51 months. Treatment distribution in the Spetzler–Martin grades I–III was as follows: 52 (54.6%) surgery, 31 (32.35%) radiosurgery, 2 (0.02%) embolization, and 11 (12%) conservative follow-up. Treatment distribution in Spetzler–Martin grades IV and V was as follows: 4 (20%) surgery, 7 (35%) radiosurgery, and 10 (45%) conservative follow-up. Poor neurologic outcome (mRS ≥ 3) was significantly associated with poor clinical status at diagnosis (Glasgow Coma Scale [GCS] score< 14; odds ratio [OR]: 0.20; 95% confidence interval [CI]: 0.001–0.396; p = 0.010). The rupture of the AVM was associated with poor neurologic outcome. The Lawton–Young Supplementary scale (LYSS) proved to be the most effective in predicting poor outcome. The existence of seizures, treatment-related complications, and conservative treatment was associated with the worsening of the mRS score, whereas the existence of hemorrhage was associated with the likelihood of disability.
Conclusion Our results suggest that poor neurologic status at diagnosis, AVM rupture, and conservative treatment were associated with worse outcome. Hemorrhage as initial presentation is related to disability, not with mRS worsening. The LYSS appeared to be the best method to predict outcome.
Publication History
Received: 08 October 2019
Accepted: 19 March 2020
Article published online:
08 December 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Kim H, Abla AA, Nelson J. et al. Validation of the supplemented Spetzler-Martin grading system for brain arteriovenous malformations in a multicenter cohort of 1009 surgical patients. Neurosurgery 2015; 76 (01) 25-31 , discussion 31–32, quiz 32–33
- 2 Al-Shahi Salman R, White PM, Counsell CE. et al; Scottish Audit of Intracranial Vascular Malformations Collaborators. Outcome after conservative management or intervention for unruptured brain arteriovenous malformations. JAMA 2014; 311 (16) 1661-1669
- 3 Korja M, Bervini D, Assaad N, Morgan MK. Role of surgery in the management of brain arteriovenous malformations: prospective cohort study. Stroke 2014; 45 (12) 3549-3555
- 4 Pollock BE, Storlie CB, Link MJ, Stafford SL, Garces YI, Foote RL. Comparative analysis of arteriovenous malformation grading scales in predicting outcomes after stereotactic radiosurgery. J Neurosurg 2017; 126 (03) 852-858
- 5 Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986; 65 (04) 476-483
- 6 Du R, Keyoung HM, Dowd CF, Young WL, Lawton MT. The effects of diffuseness and deep perforating artery supply on outcomes after microsurgical resection of brain arteriovenous malformations. Neurosurgery 2007; 60 (04) 638-646 , discussion 646–648
- 7 Gross BA, Du R. Natural history of cerebral arteriovenous malformations: a meta-analysis. J Neurosurg 2013; 118 (02) 437-443
- 8 Kim H, Al-Shahi Salman R, McCulloch CE, Stapf C, Young WL. MARS Coinvestigators. Untreated brain arteriovenous malformation: patient-level meta-analysis of hemorrhage predictors. Neurology 2014; 83 (07) 590-597
- 9 Spears J, Terbrugge KG, Moosavian M. et al. A discriminative prediction model of neurological outcome for patients undergoing surgery of brain arteriovenous malformations. Stroke 2006; 37 (06) 1457-1464
- 10 Starke RM, Kano H, Ding D. et al. Stereotactic radiosurgery for cerebral arteriovenous malformations: evaluation of long-term outcomes in a multicenter cohort. J Neurosurg 2017; 126 (01) 36-44
- 11 van Beijnum J, van der Worp HB, Buis DR. et al. Treatment of brain arteriovenous malformations: a systematic review and meta-analysis. JAMA 2011; 306 (18) 2011-2019
- 12 Laakso A, Hernesniemi J. Arteriovenous malformations: epidemiology and clinical presentation. Neurosurg Clin N Am 2012; 23 (01) 1-6
- 13 Hofmeister C, Stapf C, Hartmann A. et al. Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation. Stroke 2000; 31 (06) 1307-1310
- 14 Lawton MT, Kim H, McCulloch CE, Mikhak B, Young WL. A supplementary grading scale for selecting patients with brain arteriovenous malformations for surgery. Neurosurgery 2010; 66 (04) 702-713 , discussion 713
- 15 Pollock BE, Flickinger JC. Modification of the radiosurgery-based arteriovenous malformation grading system. Neurosurgery 2008; 63 (02) 239-243 , discussion 243
- 16 Hartmann A, Mast H, Mohr JP. et al. Determinants of staged endovascular and surgical treatment outcome of brain arteriovenous malformations. Stroke 2005; 36 (11) 2431-2435
- 17 Hartmann A, Pile-Spellman J, Stapf C. et al. Risk of endovascular treatment of brain arteriovenous malformations. Stroke 2002; 33 (07) 1816-1820
- 18 Hartmann A, Stapf C, Hofmeister C. et al. Determinants of neurological outcome after surgery for brain arteriovenous malformation. Stroke 2000; 31 (10) 2361-2364
- 19 Potts MB, Lau D, Abla AA, Kim H, Young WL, Lawton MT. UCSF Brain AVM Study Project. Current surgical results with low-grade brain arteriovenous malformations. J Neurosurg 2015; 122 (04) 912-920
- 20 Mohr JP, Moskowitz AJ, Stapf C. et al. The ARUBA trial: current status, future hopes. Stroke 2010; 41 (08) e537-e540
- 21 Tong X, Wu J, Lin F. et al. Brain arteriovenous malformations in elderly patients: clinical features and treatment outcome. Acta Neurochir (Wien) 2015; 157 (10) 1645-1653 , discussion 1653–1654
- 22 Neidert MC, Lawton MT, Mader M. The AVICH score: a novel grading system to predict clinical outcome in arteriovenous malformation-related intracerebral hemorrhage. World Neurosurg 2016; 92: 292-297