Document Detail


Multidisciplinary care of occipital arteriovenous malformations: effect on nonhemorrhagic headache, vision, and outcome in a series of 135 patients. Clinical article.
MedLine Citation:
PMID:  20059323     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: In this study, the authors evaluated how an appropriate allocation of patients with occipital arteriovenous malformations (AVMs) who were treated according to different strategies would affect nonhemorrhagic headache, visual function, and hemorrhage risk levels. METHODS: Of the 712 patients with brain AVMs in the Toronto Western Hospital prospective database, 135 had occipital AVMs. The treatment decision was based on patients' characteristics, presentation, and morphology of the AVM. The management modalities were correlated with their outcomes. RESULTS: The mean follow-up period was 6.78 years. Nonhemorrhagic headache was the most frequent symptom (82 [61%] of 135 patients). Ninety-four patients underwent treatment with one or a combination of embolization, surgery, or radiosurgery, and 41 were simply observed. Of the 40 nontreated patients with nonhemorrhagic headache, only 12 (30%) showed improvement. In the observation group 2 patients (22%) had worsening of visual symptoms, and 2 experienced hemorrhage, for an annual hemorrhage rate of 0.7% per year; 1 patient died. In the treatment group, the improvement in nonhemorrhagic headache in 35 patients (83%) was significant (p < 0.0001). Visual deficit at presentation worsened in 2 (8%), and there were 8 new visual field deficits (9%). The visual worsening was not significantly different. There were 2 other neurological deficits (2%) and 2 deaths (2%) related to the AVM treatment. One AVM hemorrhaged. The annual hemorrhage rate was 0.1% per year. The hemorrhage risk in the observation and treatment groups was lower than the observed hemorrhage risk of all patients with AVMs (4.6%) at the authors' institution. CONCLUSIONS: Appropriate selection of patients with occipital AVMs for one or a combination of treatment modalities yields a significant decrease in nonhemorrhagic headache without significant visual worsening. The multidisciplinary care of occipital AVMs can aim for an apparent decrease in hemorrhage risk.
Authors:
Amir R Dehdashti; Laurent Thines; Robert A Willinsky; Karel G terBrugge; Michael L Schwartz; Michael Tymianski; M Christopher Wallace
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  113     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-04     Completed Date:  2010-10-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  742-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Neurosurgery, Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Ontario, Canada. ardehdashti@geisinger.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Cerebral Hemorrhage / etiology
Cohort Studies
Combined Modality Therapy
Embolization, Therapeutic
Female
Follow-Up Studies
Headache / etiology,  therapy*
Humans
Intracranial Arteriovenous Malformations / complications,  therapy*
Male
Middle Aged
Nervous System Diseases / therapy
Occipital Lobe / pathology*
Radiosurgery
Treatment Outcome
Vision Disorders / etiology,  therapy*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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