Endovascular Treatment of Spetzler-Martin Grade III Arteriovenous Malformations: A Single-Center 12 years' Experience Stratified by the Spetzler-Martin Modified Scale.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
07 Jun 2024
07 Jun 2024
Historique:
received:
21
12
2023
accepted:
03
04
2024
medline:
7
6
2024
pubmed:
7
6
2024
entrez:
7
6
2024
Statut:
aheadofprint
Résumé
Limited evidence exists for endovascular first-line treatment of Spetzler-Martin (SM) grade III brain arteriovenous malformations (AVMs). In this article, we sought to evaluate advanced endovascular techniques for treating SM III AVMs across different sizes, eloquence, and patterns of venous drainage. Data from AVMs SM III treated between January 2010 and January 2022 were collected: size (S), eloquence (E), drainage (V), angioarchitecture features (arterial and venous aneurysms, venous drainage, and venous stenosis), treatment strategy (single arterial, double arterial, venous, both arterial and venous, and transvenous endovascular embolization with selective temporary flow arrest [TFATVE]), neoadjuvant treatment, and number of previous embolization sessions. AVMs were classified according to the modified SM grade as follows: small (S1V1E1/III-), medium/deep (S2V1E0/III), medium/eloquent (S2V0E1/III+), and large (S3V0E0). Treatment complications (hemorrhagic and ischemic), clinical discharge and 6-month outcomes (modified Rankin Scale 0-2, mRS), and angiographic occlusion rates were recorded. A total of 91 AVMs (62.6% ruptured, 72.5% S1V1E1, 7% S2V1E0, 19.7% S2V0E1, and 0% S3V0E0) in 91 patients (mean age 37 ± 15.8 years) were included. Treatment techniques included single arterial approach (28.6%), double arterial technique (30.8%), single venous strategy (9.9%), TFATVE (10.9%), and arterial and venous combined (19.8%). The angiographic occlusion rate was 91.2% (90.9% S1V1E1, 100% S2V1E0, and 88.9% S2V0E1) for all techniques, and 100% for the transvenous technique, isolated or combined with transarterial embolization. Minor complication (mRS 0-2), major complication (mRS >2), and mortality rate were 16.5%, 2.2%, and 3.4%, respectively. Overall, treatment morbimortality (mRS >2) was 3% (2/66) for S1V1E1, 0% for S2V1E0, and 16.7% (3/18) for S2V0E1. Although morbidity is non-negligible, endovascular treatment of SM grade III lesions with advanced techniques offers up to 100% rates of cure, which is of high interest, especially for ruptured deep-seated eloquent AVMs with high reruptured rates, and less amenable to microsurgery techniques.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Limited evidence exists for endovascular first-line treatment of Spetzler-Martin (SM) grade III brain arteriovenous malformations (AVMs). In this article, we sought to evaluate advanced endovascular techniques for treating SM III AVMs across different sizes, eloquence, and patterns of venous drainage.
METHODS
METHODS
Data from AVMs SM III treated between January 2010 and January 2022 were collected: size (S), eloquence (E), drainage (V), angioarchitecture features (arterial and venous aneurysms, venous drainage, and venous stenosis), treatment strategy (single arterial, double arterial, venous, both arterial and venous, and transvenous endovascular embolization with selective temporary flow arrest [TFATVE]), neoadjuvant treatment, and number of previous embolization sessions. AVMs were classified according to the modified SM grade as follows: small (S1V1E1/III-), medium/deep (S2V1E0/III), medium/eloquent (S2V0E1/III+), and large (S3V0E0). Treatment complications (hemorrhagic and ischemic), clinical discharge and 6-month outcomes (modified Rankin Scale 0-2, mRS), and angiographic occlusion rates were recorded.
RESULTS
RESULTS
A total of 91 AVMs (62.6% ruptured, 72.5% S1V1E1, 7% S2V1E0, 19.7% S2V0E1, and 0% S3V0E0) in 91 patients (mean age 37 ± 15.8 years) were included. Treatment techniques included single arterial approach (28.6%), double arterial technique (30.8%), single venous strategy (9.9%), TFATVE (10.9%), and arterial and venous combined (19.8%). The angiographic occlusion rate was 91.2% (90.9% S1V1E1, 100% S2V1E0, and 88.9% S2V0E1) for all techniques, and 100% for the transvenous technique, isolated or combined with transarterial embolization. Minor complication (mRS 0-2), major complication (mRS >2), and mortality rate were 16.5%, 2.2%, and 3.4%, respectively. Overall, treatment morbimortality (mRS >2) was 3% (2/66) for S1V1E1, 0% for S2V1E0, and 16.7% (3/18) for S2V0E1.
CONCLUSION
CONCLUSIONS
Although morbidity is non-negligible, endovascular treatment of SM grade III lesions with advanced techniques offers up to 100% rates of cure, which is of high interest, especially for ruptured deep-seated eloquent AVMs with high reruptured rates, and less amenable to microsurgery techniques.
Identifiants
pubmed: 38847513
doi: 10.1227/neu.0000000000003016
pii: 00006123-990000000-01198
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © Congress of Neurological Surgeons 2024. All rights reserved.
Références
Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65(4):476-483.
De Leacy R, Ansari SA, Schirmer CM, et al. Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg. 2022;14(11):1118-1124.
Lawton MT, Raso J, De Oliveira E, Han PP, Spetzler RF; UCSF Brain Arteriovenous Malformation Study Project. Spetzler-Martin grade III arteriovenous malformations: surgical results and a modification of the grading scale. Neurosurgery. 2003; 52(4):740–749.
Ding D, Starke RM, Kano H, et al. Stereotactic radiosurgery for Spetzler-Martin grade III arteriovenous malformations: an international multicenter study. J Neurosurg. 2017;126(3):859-871.
Nguyen BT, Tran HM, Huynh CT, et al. Gamma knife radiosurgery for Spetzler-Martin grade III brain arteriovenous malformations. World Neurosurg. 2023;175:e796-e803.
Potts MB, Young WL, Lawton MT, et al. Deep arteriovenous malformations in the basal ganglia, thalamus, and insula: microsurgical management, techniques, and results. Neurosurgery. 2013;73(3):417-429.
Baharvahdat H, Blanc R, Fahed R, et al. Endovascular treatment as the main approach for Spetzler–Martin grade III brain arteriovenous malformations. J Neurointerv Surg. 2021;13(3):241-246.
Hassan T, Refaat M, Issa AM, Sultan A, Ibrahim T. Geometrical characteristics of grade III arteriovenous malformations that contribute to better outcomes in endovascular treatment. World Neurosurg. 2023;180:e749-e755.
Mohr JP, Parides MK, Stapf C, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (Aruba): a multicentre, non-blinded, randomised trial. Lancet (London, England). 2014;383(9917):614-621.
Stapf C, Mast H, Sciacca RR, et al. Predictors of hemorrhage in patients with untreated brain arteriovenous malformation. Neurology. 2006;66(9):1350-1355.
da Costa L, Wallace MC, ter Brugge KG, O’Kelly C, Willinsky RA, Tymianski M. The natural history and predictive features of hemorrhage from brain arteriovenous malformations. Stroke. 2009;40(1):100-105.
Koester SW, Batista S, Bertani R, et al. Angiographic factors leading to hemorrhage in AVMs: a systematic review and meta-analysis. Neurosurg Rev. 2023;46(1):72.
Zaki Ghali MG, Kan P, Britz GW. Curative embolization of arteriovenous malformations. World Neurosurg. 2019;129:467-486.
Abud DG, Riva R, Nakiri GS, Padovani F, Khawaldeh M, Mounayer C. Treatment of brain arteriovenous malformations by double arterial catheterization with simultaneous injection of Onyx: retrospective series of 17 patients. AJNR Am J neuroradiol. 2011;32(1):152-158.
Mendes GAC, Kalani MYS, Iosif C, et al. Transvenous curative embolization of cerebral arteriovenous malformations: a prospective cohort study. Neurosurgery. 2018;83(5):957-964.
Iosif C, Almeida Filho JA, Gilbert CE, et al. Selective arterial temporary flow arrest with balloons during transvenous embolization for the treatment of brain arteriovenous malformations: a feasibility study with MRI-monitored adverse events. J Neurointerv Surg. 2022;14(12):1234-1238.
Catapano JS, Frisoli FA, Nguyen CL, et al. Spetzler-martin grade III arteriovenous malformations: a multicenter propensity-adjusted analysis of the effects of preoperative embolization. Neurosurgery. 2021;88(5):996-1002.
Burel J, Papagiannaki C, Sourour N, et al. Endovascular treatment as first-line therapy in Spetzler-Martin grade III brain arteriovenous malformations: a multicenter retrospective study. J Neurosurg. 2023;139(4):1070-1077.
Kano H, Flickinger JC, Yang HC, et al. Stereotactic radiosurgery for Spetzler-Martin Grade III arteriovenous malformations. J Neurosurg. 2014;120(4):973-981.
Ding D, Chen CJ, Starke RM, et al. Risk of brain arteriovenous malformation hemorrhage before and after stereotactic radiosurgery. Stroke. 2019;50(6):1384-1391.
Baharvahdat H, Blanc R, Termechi R, et al. Hemorrhagic complications after endovascular treatment of cerebral arteriovenous malformations. AJNR Am J Neuroradiol. 2014;35(5):978-983.
Jeon HJ, Park KY, Kim SY, Lee JW, Huh SK, Lee KC. Surgical outcomes after classifying Grade III arteriovenous malformations according to Lawton’s modified Spetzler–Martin grading system. Clin Neurol Neurosurg. 2014;124:72-80.
Abecassis IJ, Nerva JD, Feroze A, et al. Multimodality management of Spetzler-Martin Grade 3 brain arteriovenous malformations with subgroup analysis. World Neurosurg. 2017;102:263-274.
Morgan MK, Assaad N, Korja M. Surgery for unruptured Spetzler-Martin grade 3 brain arteriovenous malformations. Neurosurgery. 2015;77(3):362-370.
Luzzi S, Del Maestro M, Bongetta D, et al. Onyx embolization before the surgical treatment of grade III Spetzler-Martin brain arteriovenous malformations: single-center experience and technical nuances. World Neurosurg. 2018;116:e340-e353.
Fang YB, Byun JS, Liu JM, Krings T, Pereira VM, Brinjikji W. Transvenous embolization of brain arteriovenous malformations: a systematic review and meta-analysis. J Neurosurg Sci. 2019;63(4):468-472.
Kessler I, Riva R, Ruggiero M, Manisor M, Al-Khawaldeh M, Mounayer C. Successful transvenous embolization of brain arteriovenous malformations using Onyx in five consecutive patients. Neurosurgery. 2011;69(1):184-193.
Zaki Ghali G, Zaki Ghali MG, Zaki Ghali E. Transvenous embolization of arteriovenous malformations. Clin Neurol Neurosurg. 2019;178:70-76.
Iosif C, Mendes GAC, Saleme S, et al. Endovascular transvenous cure for ruptured brain arteriovenous malformations in complex cases with high Spetzler-Martin grades. J Neurosurg. 2015;122(5):1229-1238.
Koyanagi M, Mosimann PJ, Nordmeyer H, et al. The transvenous retrograde pressure cooker technique for the curative embolization of high-grade brain arteriovenous malformations. J Neurointerv Surg. 2021;13(7):637-641.
Lv X, Song C, He H, Jiang C, Li Y. Transvenous retrograde AVM embolization: indications, techniques, complications and outcomes. Interv Neuroradiol. 2017;23(5):504-509.
O’Reilly ST, Hendriks EJ, Itsekson Z, et al. Utilisation of the Scepter Mini dual-lumen balloon—an illustrative series. Interv Neuroradiol. 2023.
de Sousa JMB, Iosif C, Sganzerla LZ, et al. Selection of patients for treatment of brain arteriovenous malformations by the transvenous approach: relationship with venous anatomy and risk of hemorrhagic complications. Am J Neuroradiol. 2020;41(12):2311-2316.
Fahed R, Darsaut TE, Mounayer C, et al. Transvenous approach for the treatment of cerebral arteriovenous malformations (TATAM): study protocol of a randomised controlled trial. Interv Neuroradiol. 2019;25(3):305-309.
Bendok BR, El Tecle NE, El Ahmadieh TY, et al. Advances and innovations in brain arteriovenous malformation surgery. Neurosurgery. 2014;74(suppl):S60-S73.