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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Hemorrhage risk and clinical features of multiple intracranial arteriovenous malformations
Christine E Boone1, Justin M Caplan2, Wuyang Yang2
1Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Insights
Multiple arteriovenous malformations (MAVM) have a 6.7% annual hemorrhage rate, significantly higher than solitary AVMs. Combined treatment modalities are now preferred for MAVM management.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Malformations
Background:
- Multiple arteriovenous malformations (MAVM) represent a complex cerebrovascular condition.
- Understanding the clinical characteristics and hemorrhage risk is crucial for effective management.
- Previous studies have not fully elucidated the incidence and treatment outcomes specific to MAVM.
Purpose of the Study:
- To investigate the clinical features, treatment approaches, and annual hemorrhage incidence in patients diagnosed with MAVM.
- To compare the hemorrhage rate in MAVM patients with that of solitary arteriovenous malformations (AVM).
- To analyze trends in treatment strategies over time.
Main Methods:
- A systematic literature search was conducted using PubMed and EMBASE databases.
- Data from The Johns Hopkins Hospital's AVM database were also included.
- Descriptive statistics were employed to analyze demographic, clinical, and treatment outcome data for 38 MAVM patients.
Main Results:
- The annual hemorrhage incidence rate for MAVM patients was 6.7%.
- Neurological deficit (74%) and hemorrhage (63%) were the most frequent presenting symptoms.
- Surgical intervention was the primary treatment until 2011, after which multimodal strategies increased to 36%.
Conclusions:
- MAVM patients exhibit an annual hemorrhage incidence approximately two to three times higher than solitary AVM patients.
- Multimodal treatment strategies are increasingly favored for managing MAVM.
- Close patient follow-up is essential due to the potential instability of untreated or partially treated MAVM nidi.
Abstract:
The aim of this report is to examine clinical characteristics, treatment strategies, and annual hemorrhage incidence rate for patients with multiple arteriovenous malformations (MAVM). The PubMed and EMBASE databases and the arteriovenous malformations (AVM) database at The Johns Hopkins Hospital were searched to identify patients with MAVM. Data related to demographics, clinical features, management, and treatment outcomes were analyzed with descriptive statistics. Thirty-eight patients met the inclusion criteria. The annual hemorrhage incidence rate was 6.7%. Surgical intervention remained the most common single-modality treatment from 1949-2011. Between 1990 and 2011, multiple-modality treatment strategies (36% of cases) were employed more frequently. The most common presenting features were neurological deficit (74%) and hemorrhage (63%). In patients undergoing staged treatment of MAVM, hemorrhage of an untreated nidus (n=5), visualization of a new nidus (n=9), and disappearance of an untreated nidus (n=2) were observed. Limitations of this study include small sample size and reporting bias. The annual hemorrhage incidence rate for MAVM patients was approximately two- to three-fold greater than the reported annual hemorrhage rates for solitary AVM. Combining different treatment modalities has become the most common management strategy. The potential instability of remaining nidi with staged or incomplete treatment necessitates close follow-up in these cases.
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