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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Exclusion treatment of ruptured and unruptured low-grade brain arteriovenous malformations: a systematic review
Maichael Talaat1,2, Kévin Premat3, Stéphanie Lenck3
1Department of Interventional Neuroradiology, GRC BioFast, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 75013, Paris, France.
Purpose:
To assess the obliteration rate, functional outcome, hemorrhagic complication, and mortality rates of exclusion treatment of low-grade brain arteriovenous malformations (BAVMs) (Spetzler and Martin grades (SMGs) 1 and 2), either ruptured or unruptured.
Methods:
Electronic databases-Ovid MEDLINE and PubMed-were searched for studies in which there was evidence of exclusion treatment of low-grade BAVMs treated either by endovascular, surgical, radiosurgical, or multimodality treatment. The primary outcome of interest was angiographic obliteration post-treatment and at follow-up. The secondary outcomes of interest were functional outcome (mRS), mortality rate, and hemorrhagic complication. Descriptive statistics were used to calculate rates and means.
Results:
Eleven studies involving 1809 patients with low-grade BAVMs were included. Among these, 1790 patients treated by either endovascular, surgical, radiosurgical, or multimodality treatment were included in this analysis. Seventy-two percent of BAVMs were Spetzler-Martin grade II. The overall (i.e., including all exclusion treatment modalities) complete obliteration rate ranged from 36.5 to 100%. The overall symptomatic hemorrhagic complication rate ranged from 0 to 7.3%; procedure-related mortality ranged from 0 to 4.7%.
Conclusion:
Our systematic review of the literature reveals a high overall obliteration rate for low-grade BAVMs, either ruptured or unruptured, with low mortality rate and an acceptable post-treatment hemorrhagic complication rate. These results suggest that exclusion treatment of low-grade BAVMs may be safe and effective, regardless of the treatment modality chosen.
Insights
Exclusion treatment for low-grade brain arteriovenous malformations (BAVMs) shows high obliteration rates. This systematic review confirms that treatment is safe and effective, with low mortality and acceptable complication rates.
Area of Science:
- Neurosurgery
- Interventional Neurology
- Radiology
Background:
- Low-grade brain arteriovenous malformations (BAVMs), Spetzler-Martin grades 1 and 2, pose treatment challenges.
- Assessing outcomes of exclusion treatment for BAVMs is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the obliteration rate, functional outcomes, and complication rates of exclusion treatment for low-grade BAVMs.
- To analyze outcomes for both ruptured and unruptured BAVMs.
Main Methods:
- Systematic review of electronic databases (Ovid MEDLINE, PubMed) for exclusion treatment of low-grade BAVMs.
- Included studies utilized endovascular, surgical, radiosurgical, or multimodality approaches.
- Primary outcome: angiographic obliteration; Secondary outcomes: functional outcome (mRS), mortality, hemorrhagic complications.
Main Results:
- Eleven studies with 1809 patients (1790 analyzed) were included.
- Overall complete obliteration rates ranged from 36.5% to 100%.
- Symptomatic hemorrhagic complication rates were 0-7.3%; procedure-related mortality was 0-4.7%.
Conclusions:
- Exclusion treatment for low-grade BAVMs demonstrates high obliteration rates.
- Treatment is associated with low mortality and acceptable hemorrhagic complication rates.
- Exclusion treatment appears safe and effective for low-grade BAVMs, irrespective of modality.
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