Matthew B Potts1, Arman Jahangiri1, Maxwell Jen1, Penny K Sneed2, Michael W McDermott1, Nalin Gupta3, Steven W Hetts4, William L Young5, Michael T Lawton6. 1. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA. 2. Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA. 3. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA; Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA. 4. Department of Radiology, University of California, San Francisco, San Francisco, California, USA. 5. Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA; Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California, USA. 6. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA; Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California, USA. Electronic address: lawtonm@neurosurg.ucsf.edu.
Abstract
OBJECTIVE: This study sought to describe a single institution's experience treating arteriovenous malformations (AVMs) of the basal ganglia, thalamus, and insula in a multimodal fashion. METHODS: We conducted a retrospective review of all deep AVMs treated at our institution between 1997 and 2011 with attention to patient selection, treatment strategies, and radiographic and functional outcomes. RESULTS: A total of 97 patients underwent initial treatment at our institution. 64% presented with hemorrhage with 29% located in the basal ganglia, 41% in the thalamus, and 30% in the insula. 80% were Spetzler-Martin grade III-IV. Initial treatment was microsurgical resection in 42%, stereotactic radiosurgery (SRS) in 45%, and observation in 12%. Radiographic cure was achieved in 54% after initial surgical or SRS treatment (71% and 23%, respectively) and in 63% after subsequent treatments, with good functional outcomes in 78% (median follow-up 2.2 years). Multivariate logistic regression analysis revealed treatment group and age as factors associated with radiographic cure, whereas Spetzler-Martin score and time to follow-up were significantly associated with improved/unchanged functional status at time of last follow-up. Posttreatment hemorrhage occurred in 11% (7% of surgical and 18% of SRS patients). CONCLUSIONS: Modern treatment of deep AVMs includes a multidisciplinary approach utilizing microsurgery, SRS, embolization, and observation. Supplementary grading adds meaningfully to traditional Spetzler-Martin grading to guide patient selection. Surgical resection is more likely to result in obliteration compared with SRS, and is associated with satisfactory results in carefully selected patients.
OBJECTIVE: This study sought to describe a single institution's experience treating arteriovenous malformations (AVMs) of the basal ganglia, thalamus, and insula in a multimodal fashion. METHODS: We conducted a retrospective review of all deep AVMs treated at our institution between 1997 and 2011 with attention to patient selection, treatment strategies, and radiographic and functional outcomes. RESULTS: A total of 97 patients underwent initial treatment at our institution. 64% presented with hemorrhage with 29% located in the basal ganglia, 41% in the thalamus, and 30% in the insula. 80% were Spetzler-Martin grade III-IV. Initial treatment was microsurgical resection in 42%, stereotactic radiosurgery (SRS) in 45%, and observation in 12%. Radiographic cure was achieved in 54% after initial surgical or SRS treatment (71% and 23%, respectively) and in 63% after subsequent treatments, with good functional outcomes in 78% (median follow-up 2.2 years). Multivariate logistic regression analysis revealed treatment group and age as factors associated with radiographic cure, whereas Spetzler-Martin score and time to follow-up were significantly associated with improved/unchanged functional status at time of last follow-up. Posttreatment hemorrhage occurred in 11% (7% of surgical and 18% of SRSpatients). CONCLUSIONS: Modern treatment of deep AVMs includes a multidisciplinary approach utilizing microsurgery, SRS, embolization, and observation. Supplementary grading adds meaningfully to traditional Spetzler-Martin grading to guide patient selection. Surgical resection is more likely to result in obliteration compared with SRS, and is associated with satisfactory results in carefully selected patients.
Authors: H Baharvahdat; R Blanc; R Fahed; S Smajda; G Ciccio; J-P Desilles; H Redjem; S Escalard; M Mazighi; D Chauvet; T Robert; P Sasannejad; M Piotin Journal: AJNR Am J Neuroradiol Date: 2019-02-21 Impact factor: 3.825
Authors: Pablo García Feijoo; Javier Manuel Saceda Gutiérrez; Remedios Frutos Martínez; Miguel Sáez Alegre; Catalina Vivancos Sánchez; Fernando Eliseo Carceller Benito Journal: Childs Nerv Syst Date: 2020-09-15 Impact factor: 1.475