Clinical outcomes of posterior fossa arteriovenous malformations: a single center experience.
Clinical outcome
Posterior fossa arteriovenous malformations
Prognostic factors
Treatment modalities
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
14 May 2024
14 May 2024
Historique:
received:
10
01
2024
accepted:
05
05
2024
medline:
15
5
2024
pubmed:
15
5
2024
entrez:
14
5
2024
Statut:
epublish
Résumé
Posterior fossa arterio-venous malformations (pfAVMs) are challenging lesions due to the anatomical particularities of the posterior fossa, and the high incidence of hemorrhagic presentation. The two most important goals when treating AVMs are preserving neurological function and preventing rupture, or a second hemorrhage. The aim of this study was to analyze the clinical and imaging features of pfAVMs to identify the factors that influence the prognosis of these patients. We conducted a single-center retrospective observational study that included patients treated at our institution with pfAVMs between January 1997 and December 2021. A total of 48 patients were included. A good modified Rankin score (mRS) was observed in 33 cases (69%) at presentation. Thirty-four patients (71%) presented with a ruptured AVM. Out of these, 19 patients (40%) had intraventricular hemorrhage. Microsurgical resection was performed in 33 cases (69%), while in the other cases, the patients opted for conservative management (7 cases, 15%), stereotactic radiosurgery (SRS) (6 cases, 12%), or endovascular treatment (2 cases, 4%). Patients ≤ 30 years old were more prone to hemorrhagic presentation (OR: 5.23; 95% CI: 1.42-17.19; p = 0.024) and this remained an independent risk factor for rupture after multivariate analysis as well (OR: 4.81; 95% CI: 1.07-21.53; p = 0.040). Following multivariate analysis, the only factor independently associated with poor prognosis in the surgically treated subgroup was a poor clinical status (mRS 3-5) at admission (OR: 96.14; 95% CI: 5.15-1793.9; p = 0.002). Management of posterior fossa AVMs is challenging, and patients who present with ruptured AVMs often have a poor clinical status at admission leading to a poor prognosis. Therefore, proper and timely management of these patients is essential.
Sections du résumé
BACKGROUND
BACKGROUND
Posterior fossa arterio-venous malformations (pfAVMs) are challenging lesions due to the anatomical particularities of the posterior fossa, and the high incidence of hemorrhagic presentation. The two most important goals when treating AVMs are preserving neurological function and preventing rupture, or a second hemorrhage. The aim of this study was to analyze the clinical and imaging features of pfAVMs to identify the factors that influence the prognosis of these patients.
METHODS
METHODS
We conducted a single-center retrospective observational study that included patients treated at our institution with pfAVMs between January 1997 and December 2021.
RESULTS
RESULTS
A total of 48 patients were included. A good modified Rankin score (mRS) was observed in 33 cases (69%) at presentation. Thirty-four patients (71%) presented with a ruptured AVM. Out of these, 19 patients (40%) had intraventricular hemorrhage. Microsurgical resection was performed in 33 cases (69%), while in the other cases, the patients opted for conservative management (7 cases, 15%), stereotactic radiosurgery (SRS) (6 cases, 12%), or endovascular treatment (2 cases, 4%). Patients ≤ 30 years old were more prone to hemorrhagic presentation (OR: 5.23; 95% CI: 1.42-17.19; p = 0.024) and this remained an independent risk factor for rupture after multivariate analysis as well (OR: 4.81; 95% CI: 1.07-21.53; p = 0.040). Following multivariate analysis, the only factor independently associated with poor prognosis in the surgically treated subgroup was a poor clinical status (mRS 3-5) at admission (OR: 96.14; 95% CI: 5.15-1793.9; p = 0.002).
CONCLUSIONS
CONCLUSIONS
Management of posterior fossa AVMs is challenging, and patients who present with ruptured AVMs often have a poor clinical status at admission leading to a poor prognosis. Therefore, proper and timely management of these patients is essential.
Identifiants
pubmed: 38744729
doi: 10.1007/s00701-024-06116-9
pii: 10.1007/s00701-024-06116-9
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
215Informations de copyright
© 2024. The Author(s).
Références
Arnaout OM, Gross BA, Eddleman CS, Bendok BR, Getch CC, Batjer HH (2009) Posterior fossa arteriovenous malformations. Neurosurg Focus FOC 26:E12. https://doi.org/10.3171/2009.2.Focus0914
doi: 10.3171/2009.2.Focus0914
Cenzato M, Tartara F, D’Aliberti G, Bortolotti C, Cardinale F, Ligarotti G, Debernardi A, Fratianni A, Boccardi E, Stefini R, Zenga F, Boccaletti R, Lanterna A, Pavesi G, Ferroli P, Sturiale C, Ducati A, Cardia A, Piparo M, Valvassori L, Piano M (2018) Unruptured versus ruptured AVMs: outcome analysis from a multicentric consecutive series of 545 surgically treated cases. World Neurosurg 110:e374–e382. https://doi.org/10.1016/j.wneu.2017.11.003
doi: 10.1016/j.wneu.2017.11.003
pubmed: 29155066
Corniola MV, Meling TR, Bijlenga P, Bernava G, Machi P, Schaller K (2020) Posterior fossa arteriovenous malformations: experience with 14 patients and a systematic review of the literature. J Neurol Surg A Cent Eur Neurosurg 81:170–176. https://doi.org/10.1055/s-0039-1691820
doi: 10.1055/s-0039-1691820
pubmed: 31659722
da Costa L, Thines L, Dehdashti AR, Wallace MC, Willinsky RA, Tymianski M, Schwartz ML, Brugge KGT (2009) Management and clinical outcome of posterior fossa arteriovenous malformations: report on a single-centre 15-year experience. J Neurol, Neurosurg Psychiatr 80:376–379. https://doi.org/10.1136/jnnp.2008.152710
doi: 10.1136/jnnp.2008.152710
Darsaut TE, Magro E, Bojanowski MW, Chaalala C, Nico L, Bacchus E, Klink R, Iancu D, Weill A, Roy D, Sabatier J-F, Cognard C, Januel A-C, Pelissou-Guyotat I, Eker O, Roche P-H, Graillon T, Brunel H, Proust F, Beaujeux R, Aldea S, Piotin M, Cornu P, Shotar E, Gaberel T, Barbier C, Corre ML, Costalat V, Jecko V, Barreau X, Morandi X, Gauvrit J-Y, Derrey S, Papagiannaki C, Nguyen TN, Abdalkader M, Tawk RG, Huynh T, Viard G, Gevry G, Gentric J-C, Raymond J, Raymond J, Roy D, Weill A, Iancu D, Bojanowski MW, Chaalala C, Darsaut TE, Rempel JL, O’Kelly CJ, Chow MMC, Findlay JM, Fahed R, Lesiuk H, Drake B, Santos Md, Gentric J-C, Magro E, Seizeur R, Nonent M, Timsit S, Pradier O, Ognard J, El-Aouni MC, Desal H, Boursier R, Thillays F, Roualdes V, Piotin M, Aldea S, Blanc R, Cognard C, Januel A-C, Sabatier J-F, Calviere L, Gauvrit JY, Lecouillard I, Morandi X, Nouhaud E, Raoult H, Eugene F, Bras AL, Ferre J-C, Paya C, Ronziere T, Trystram D, Naggara O, Rodriguez-Regent C, Kerleroux B, Gaberel T, Barbier C, Emery E, Touze E, Papagiannaki C, Derrey S, Pellisou-Guyotat I, Eker O, Guyotat J, Berhouma M, Riva R, Dumot C, Biondi A, Thines L, Charbonnier G, Bougaci N, Bracard S, Anxionnat R, Bernier-Chastagner V, Civit T, Gory B, Barreau X, Jecko V, Penchet G, Gimbert E, Marnat G, Huchet A, Herbreteau D, Boulouis G, Velut S, Bibi R, Ifergan H, Janot K, Roche P-H, Graillon T, Brunel H, Peyriere H, Kaya J-M, Touta A, Troude L, Boissonneau S, Shotar E, Boch A-L, Cornu P, Clarençon F, Sourour N, Nouet A, Lenck S, Premat K, Costalat V, Corre ML, Bonafe A, Dargazanli C, Gascou G, Lefevre P-H, Riquelme C, Proust F, Beaujeux R, Cebula H, Ollivier I, Pop R, Spatola G, Spelle L, Chalumeau V, Gallas S, Ikka L, Mihalea C, Ozanne A, Caroff J, Chabert E, Mounayer C, Rouchaud A, Caire F, Ricolfi F, Cao C, Mourier K-L, Thouant P, Farah W, Nguyen TN, Abdalkader M, Tawk RG, Huynh T, Carlson AP, Silva LAO, Froio NdL, Silva GS, Montalverne FJA, Martins JL, Mendes GN, Miranda RR (2023) Surgical treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial. J Neurosurg 138:891–899. https://doi.org/10.3171/2022.7.JNS22813
doi: 10.3171/2022.7.JNS22813
pubmed: 36087316
Dinc N, Platz J, Tritt S, Quick-Weller J, Eibach M, Wolff R, Berkefeld J, Seifert V, Marquardt G (2018) Posterior fossa AVMs: Increased risk of bleeding and worse outcome compared to supratentorial AVMs. J Clin Neurosci 53:171–176. https://doi.org/10.1016/j.jocn.2018.04.010
doi: 10.1016/j.jocn.2018.04.010
pubmed: 29685412
Fults D, Kelly DLJ (1984) Natural history of arteriovenous malformations of the brain: a clinical study. Neurosurgery 15:658–662
doi: 10.1227/00006123-198411000-00003
pubmed: 6504280
Garzelli L, Shotar E, Blauwblomme T, Sourour N, Alias Q, Stricker S, Mathon B, Kossorotoff M, Gariel F, Boddaert N, Brunelle F, Meyer P, Naggara O, Clarençon F, Boulouis G (2020) Risk factors for early brain AVM rupture: cohort study of pediatric and adult patients. Am J Neuroradiol 41:2358–2363. https://doi.org/10.3174/ajnr.A6824
doi: 10.3174/ajnr.A6824
pubmed: 33122204
pmcid: 7963239
Hazra A, Gogtay N (2017) Biostatistics series module 10: brief overview of multivariate methods. Indian J Dermatol 62:358–366. https://doi.org/10.4103/ijd.IJD_296_17
doi: 10.4103/ijd.IJD_296_17
pubmed: 28794544
pmcid: 5527714
Kato Y, Dong V, Chaddad F, Takizawa K, Izumo T, Fukuda H, Hara T, Kikuta K, Nakai Y, Endo T, Kurita H, Xu B, Beneš V, Christian R, Pavesi G, Hodaie M, Sharma R, Agarwal H, Mohan K, Liew B (2019) Expert consensus on the management of brain arteriovenous malformations. Asian J Neurosurg 14:1074–1081. https://doi.org/10.4103/ajns.AJNS_234_19
doi: 10.4103/ajns.AJNS_234_19
pubmed: 31903343
pmcid: 6896626
Kelly ME, Guzman R, Sinclair J, Bell-Stephens TE, Bower R, Hamilton S, Marks MP, Do HM, Chang SD, Adler JR, Levy RP, Steinberg GK (2008) Multimodality treatment of posterior fossa arteriovenous malformations. J Neurosurg JNS 108:1152–1161. https://doi.org/10.3171/jns/2008/108/6/1152
doi: 10.3171/jns/2008/108/6/1152
Khaw AV, Mohr JP, Sciacca RR, Schumacher HC, Hartmann A, Pile-Spellman J, Mast H, Stapf C (2004) Association of infratentorial brain arteriovenous malformations with hemorrhage at initial presentation. Stroke 35:660–663. https://doi.org/10.1161/01.STR.0000117093.59726.F9
doi: 10.1161/01.STR.0000117093.59726.F9
pubmed: 14752127
Lawton MT, Du R, Tran MN, Achrol AS, McCulloch CE, Johnston SC, Quinnine NJ, Young WL (2005) Effect of presenting hemorrhage on outcome after microsurgical resection of brain arteriovenous malformations. Neurosurgery 56:485–493. https://doi.org/10.1227/01.Neu.0000153924.67360.Ea
doi: 10.1227/01.Neu.0000153924.67360.Ea
pubmed: 15730573
Miyamoto S, Hashimoto N, Nagata I, Nozaki K, Morimoto M, Taki W, Kikuchi H (2000) Posttreatment sequelae of palliatively treated cerebral arteriovenous malformations. Neurosurgery 46:589–595
doi: 10.1097/00006123-200003000-00013
pubmed: 10719855
Mohr JP, Parides MK, Stapf C, Moquete E, Moy CS, Overbey JR, Salman RA-S, Vicaut E, Young WL, Houdart E, Cordonnier C, Stefani MA, Hartmann A, von Kummer R, Biondi A, Berkefeld J, Klijn CJM, Harkness K, Libman R, Barreau X, Moskowitz AJ (2014) Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. The Lancet 383:614–621. https://doi.org/10.1016/S0140-6736(13)62302-8
doi: 10.1016/S0140-6736(13)62302-8
Nisson PL, Fard SA, Walter CM, Johnstone CM, Mooney MA, Tayebi Meybodi A, Lang M, Kim H, Jahnke H, Roe DJ, Dumont TM, Lemole GM, Spetzler RF, Lawton MT (2019) A novel proposed grading system for cerebellar arteriovenous malformations. J Neurosurg 132:1105–1115. https://doi.org/10.3171/2018.12.JNS181677
doi: 10.3171/2018.12.JNS181677
pubmed: 30849761
pmcid: 6856412
Orning J, Amin-Hanjani S, Hamade Y, Du X, Hage ZA, Aletich V, Charbel F, Alaraj A (2016) Increased prevalence and rupture status of feeder vessel aneurysms in posterior fossa arteriovenous malformations. J NeuroIntervent Surg 8:1021–1024. https://doi.org/10.1136/neurintsurg-2015-012005
doi: 10.1136/neurintsurg-2015-012005
Pohjola A, Lehto H, Hafez A, Oulasvirta E, Koroknay-Pál P, Laakso A (2018) Arteriovenous malformations of the posterior fossa: focus on surgically treated patients presenting with hemorrhage. World Neurosurgery 116:e934–e943. https://doi.org/10.1016/j.wneu.2018.05.138
doi: 10.1016/j.wneu.2018.05.138
pubmed: 29857215
Robert T, Blanc R, Ciccio G, Gilboa B, Fahed R, Boissonnet H, Redjem H, Pistocchi S, Bartolini B, Piotin M (2016) Endovascular treatment of posterior fossa arteriovenous malformations. J Clin Neurosci 25:65–68. https://doi.org/10.1016/j.jocn.2015.05.051
doi: 10.1016/j.jocn.2015.05.051
pubmed: 26549679
Rodríguez-Hernández A, Kim H, Pourmohamad T, Young WL, Lawton MT, for the University of California SFAMSP (2012) Cerebellar arteriovenous malformations: anatomic subtypes, surgical results, and increased predictive accuracy of the supplementary grading system. Neurosurgery 71:1111–1124. https://doi.org/10.1227/NEU.0b013e318271c081
doi: 10.1227/NEU.0b013e318271c081
pubmed: 22986595
Specogna AV, Turin TC, Patten SB, Hill MD (2014) Factors associated with early deterioration after spontaneous intracerebral hemorrhage: a systematic review and meta-analysis. PLoS ONE 9:e96743. https://doi.org/10.1371/journal.pone.0096743
doi: 10.1371/journal.pone.0096743
pubmed: 24809990
pmcid: 4014549
Stapf C, Khaw AV, Sciacca RR, Hofmeister C, Schumacher HC, Pile-Spellman J, Mast H, Mohr JP, Hartmann A (2003) Effect of age on clinical and morphological characteristics in patients with brain arteriovenous malformation. Stroke 34:2664–2669. https://doi.org/10.1161/01.STR.0000094824.03372.9B
doi: 10.1161/01.STR.0000094824.03372.9B
pubmed: 14576378
Stapf C, Mast H, Sciacca RR, Choi JH, Khaw AV, Connolly ES, Pile-Spellman J, Mohr JP (2006) Predictors of hemorrhage in patients with untreated brain arteriovenous malformation. Neurology 66:1350–1355. https://doi.org/10.1212/01.wnl.0000210524.68507.87
doi: 10.1212/01.wnl.0000210524.68507.87
pubmed: 16682666
Stapf C, Mohr JP, Pile-Spellman J, Sciacca RR, Hartmann A, Schumacher HC, Mast H (2002) Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation. J Neurol Neurosurg Psychiatr 73:294–298. https://doi.org/10.1136/jnnp.73.3.294
doi: 10.1136/jnnp.73.3.294
Stein K-P, Wanke I, Forsting M, Oezkan N, Huetter B-O, Sandalcioglu IE, Sure U (2016) Associated aneurysms in infratentorial arteriovenous malformations: role of aneurysm size and comparison with supratentorial lesions. Cerebrovasc Dis 41:219–225. https://doi.org/10.1159/000443540
doi: 10.1159/000443540
pubmed: 26795269
Stein K-P, Wanke I, Schlamann M, Dammann P, Moldovan A-S, Zhu Y, Sure U, Sandalcioglu IE (2014) Posterior fossa arterio-venous malformations: current multimodal treatment strategies and results. Neurosurg Rev 37:619–628. https://doi.org/10.1007/s10143-014-0551-9
doi: 10.1007/s10143-014-0551-9
pubmed: 24811220
Thines L, Dehdashti AR, da Costa L, Tymianski M, ter Brugge KG, Willinsky RA, Schwartz M, Wallace M (2012) Challenges in the management of ruptured and unruptured brainstem arteriovenous malformations: outcome after conservative, single-modality, or multimodality treatments. Neurosurgery 70:155–161. https://doi.org/10.1227/NEU.0b013e31822670ac
doi: 10.1227/NEU.0b013e31822670ac
pubmed: 21637136
Tong X, Wu J, Lin F, Cao Y, Zhao Y, Wang S, Zhao J (2016) Cerebellar arteriovenous malformations: clinical feature, risk of hemorrhage and predictors of posthemorrhage outcome. World Neurosurgery 92:206–217. https://doi.org/10.1016/j.wneu.2016.05.006
doi: 10.1016/j.wneu.2016.05.006
pubmed: 27178234
Yang W, Wang JY, Caplan JM, Braileanu M, Shang H, Upadhyay U, Zenonos GA, Rigamonti D, Colby GP, Coon AL, Tamargo RJ, Huang J (2015) Predictors of functional outcome following treatment of posterior fossa arteriovenous malformations. J Clin Neurosci 22:357–362. https://doi.org/10.1016/j.jocn.2014.08.007
doi: 10.1016/j.jocn.2014.08.007
pubmed: 25439748
Yilmaz A, Musluman AM, Kanat A, Cavusoglu H, Terzi Y, Aydin Y (2011) The correlation between hematoma volume and outcome in ruptured posterior fossa arteriovenous malformations indicates the importance of surgical evacuation of hematomas. Turk Neurosurg 21:152–159. https://doi.org/10.5137/1019-5149.Jtn.3401-10.0
doi: 10.5137/1019-5149.Jtn.3401-10.0
pubmed: 21534195