Document Detail


Determinants of staged endovascular and surgical treatment outcome of brain arteriovenous malformations.
MedLine Citation:
PMID:  16224095     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Therapy of brain arteriovenous malformations (AVMs) often requires the combination of different treatment modalities. Independently assessed data on neurologic outcome after multidisciplinary AVM therapy are scarce. METHODS: The 119 consecutive patients (49% women, mean age 34+/-13 years) with brain AVMs receiving endovascular embolization followed by surgical treatment were analyzed. Neurologic impairment was assessed prospectively by a neurologist using the modified Rankin Scale (mRS) before, during, and after completed AVM therapy. The association of demographic, clinical, and morphologic characteristics with new treatment-related neurologic deficits was calculated. RESULTS: The 119 patients were treated with 240 superselective embolizations (median, 2; range, 1 to 8) using n-butyl cyanoacrylate. Mean follow-up time after surgery was 9.6+/-13.2 months. On the Spetzler-Martin scale, 8% of the AVMs were grade 1, 27% grade 2, 40% grade 3, 22% grade 4, and 3% grade 5. Disabling treatment-related complications (mRS> or =3) occurred in 5% (95% confidence interval [CI], 1% to 9%) of the patients. Nondisabling new deficits were observed in another 42% (95% CI, 33% to 51%). No patient died. Nonhemorrhagic AVM presentation (odds ratio [OR], 5.00; 95% CI, 1.75 to 14.29), deep venous drainage (OR, 3.09; 95% CI, 1.43 to 6.64), AVM location in an eloquent brain region (OR, 2.42; 95% CI, 1.10 to 5.33), and large AVM size (OR, 1.05; 95% CI, 1.01 to 1.09) were independently associated with new treatment-related deficits. CONCLUSIONS: Our results suggest an increased treatment risk for patients with previously unbled AVMs from combined endovascular and surgical AVM therapy. Additional risk factors for treatment-related neurologic deficits may be large AVM size, deep venous drainage, and AVM location in eloquent brain regions.
Authors:
Andreas Hartmann; Henning Mast; Jay P Mohr; John Pile-Spellman; E Sander Connolly; Robert R Sciacca; Alexander Khaw; Christian Stapf
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.     Date:  2005-10-13
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  36     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-10-27     Completed Date:  2006-02-22     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2431-5     Citation Subset:  IM    
Affiliation:
Doris and Stanley Tananbaum Stroke Center, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA. ahart@zedat.fu-berlin.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Brain / pathology*
Brain Diseases
Bucrylate / pharmacology
Cerebral Angiography
Cerebral Hemorrhage / pathology
Child
Embolization, Therapeutic / methods
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / diagnosis,  pathology*
Male
Microcirculation
Middle Aged
Odds Ratio
Prospective Studies
Regression Analysis
Risk
Risk Factors
Time Factors
Tissue Adhesives / pharmacology
Treatment Outcome
Grant Support
ID/Acronym/Agency:
R01 NS 40792-01/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Tissue Adhesives; 1069-55-2/Bucrylate

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