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Spetzler martin

Waleed Brinjikji, Vivek N Iyer, Christopher P Wood, Giuseppe Lanzino
OBJECTIVE Patients with hereditary hemorrhagic telangiectasia (HHT) are known to suffer from high rates of cerebral arteriovenous malformations (AVMs). The authors performed a systematic review and meta-analysis of the literature examining prevalence rates, characteristics, and clinical presentation of cerebral AVMs in the HHT population. METHODS To identify studies on AVM prevalence and characteristics in the HHT population, 4 databases (MEDLINE, EMBASE, Scopus and Web of Science) were searched by a reference librarian with over 30 years experience in systematic reviews and meta-analysis...
October 21, 2016: Journal of Neurosurgery
Klaus-Peter Stein, Isabel Wanke, Neriman Oezkan, Yuan Zhu, I Erol Sandalcioglu, Michael Forsting, Ulrich Sure
BACKGROUND: Multiple AVMs are exceptionally rare lesions and only a few larger series have been published, including other vascular pathologies, such as arterio-venous fistulae (AVF) or patients with hereditary syndromes. Our study presents clinical, angiographic, and therapeutic characteristics of patients harboring sporadic multiple AVMs. METHODS: Basic demographic data, vascular architecture, clinical presentation, treatment strategies, and treatment outcome were analyzed retrospectively from patients with cerebral AVMs treated in our department between 1990 and 2015...
October 20, 2016: Acta Neurochirurgica
Tilman Schubert, Yijing Wu, Kevin M Johnson, Oliver Wieben, Jane Maksimovic, Charles Mistretta, Patrick Turski
OBJECTIVES: Time-of-arrival (TOA) maps can be derived from high-resolution 4-dimensional (4D) contrast-enhanced magnetic resonance angiography (MRA) data sets to provide a quantitative description of contrast material arrival time in each voxel. This information can further be processed to create a compressed time evolution curve that virtually shortens the contrast bolus (virtual bolus [VB]). The purpose of this project was to determine whether TOA-enhanced 4D MRA and/or VB imaging improve the display of contrast kinetics in patients with vascular disease...
November 2016: Investigative Radiology
Stefan Knippen, Florian Putz, Sabine Semrau, Ulrike Lambrecht, Arzu Knippen, Michael Buchfelder, Sven Schlaffer, Tobias Struffert, Rainer Fietkau
BACKGROUND: Intracranial arteriovenous malformations (AVMs) may show a harmful development. AVMs are treated by surgery, embolization, or radiation therapy. OBJECTIVE: This study investigated obliteration rates and side effects in patients with AVMs treated by radiation therapy. METHODS: A total of 40 cases treated between 2005 and 2013 were analyzed. Single-dose stereotactic radiosurgery (SRS) was received by 13 patients and 27 received hypofractionated stereotactic radiation therapy (HSRT)...
October 18, 2016: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
Or Cohen-Inbar, Robert M Starke, Hideyuki Kano, Gregory Bowden, Paul Huang, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S Grills, David Mathieu, Danilo Silva, Mahmoud Abbassy, Symeon Missios, John Y K Lee, Gene H Barnett, Douglas Kondziolka, L Dade Lunsford, Jason P Sheehan
OBJECTIVE Cerebellar arteriovenous malformations (AVMs) represent the majority of infratentorial AVMs and frequently have a hemorrhagic presentation. In this multicenter study, the authors review outcomes of cerebellar AVMs after stereotactic radiosurgery (SRS). METHODS Eight medical centers contributed data from 162 patients with cerebellar AVMs managed with SRS. Of these patients, 65% presented with hemorrhage. The median maximal nidus diameter was 2 cm. Favorable outcome was defined as AVM obliteration and no posttreatment hemorrhage or permanent radiation-induced complications (RICs)...
September 30, 2016: Journal of Neurosurgery
Ipek Arslan, Evrim Tezcanli, Meltem Yilmaz, Olcay Cizmeli, Meric Sengoz, Selcuk Peker
AIM: Cerebral arteriovenous malformations (AVM) are pathological connections between arteries and veins without capillaries. Stereotactic radiosurgery (RS) is a proven and accepted treatment method for cerebral AVMs. Our objective was to analyze the factors influencing the clinical outcome in patients suffering from AVMs. MATERIAL AND METHODS: We retrospectively reviewed 199 patients who were treated with Gamma-Knife RS for intracranial AVMs between 13 October 2005 and 31 October 2010...
September 21, 2015: Turkish Neurosurgery
William R Stetler, Adam J Polikfa, W Christopher Fox, Brian Hoh
A 35-year-old male presented with headaches and was found to have a Spetzler-Martin grade 2 right occipital arteriovenous malformation (AVM) with single, superficial draining vein. The patient opted to undergo embolization for possible cure with resection scheduled in the event complete obliteration was not achieved. Three weeks later, angiography during his embolization procedure revealed that the AVM had spontaneously obliterated; no treatment was required. In conjunction with prior case reports/series, this patient highlights the need for current imaging prior to proceeding with intervention to confirm that spontaneous obliteration has not occurred between diagnosis and treatment...
July 26, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Evandro C Sousa, Manoel J Teixeira, Ronnie L Piske, Lavoisier S Albuquerque, Sebastião Côrrea, Salomão Benabou, Leonardo C Welling, Leonardo Moura de Sousa, Eberval Gadelha Figueiredo
OBJECTIVE: To evaluate the role of preradiosurgical embolization on obliteration rate, reduction of size, irradiation dose, and neurological outcome, in 90 patients presenting large arteriovenous malformations (AVMs). METHODS: Between October 1993 and October 2006, 90 radiosurgical procedures were performed to treat brain AVMs Spetzler-Martin (SM) grades III, IV, and V at the Department of Radiosurgery and Radiology of the Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, Brazil...
2016: Frontiers in Surgery
Orlando Diaz, Robert Scranton
Cerebral arteriovenous malformations (AVM) are tangles of blood vessels that permit shunting of blood from the arterial to venous phase without intervening capillaries. The malformation's arterialization of a low-pressure system creates a risk of rupture that is substantially higher when associated with an aneurysm. The annual hemorrhage rate is 2.2% per year as reported in the randomized trial of unruptured brain AVMs (ARUBA; rupture risk is increased after the first event. Ruptured AVMs have a 10% mortality rate and 20%-30% morbidity rate...
2016: Handbook of Clinical Neurology
Jan P Boström, Ruth Bruckermann, Bogdan Pintea, Azize Boström, Gunnar Surber, Klaus Hamm
OBJECTIVE: To review outcomes after LINAC stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (hfSRT) of arteriovenous malformations (AVM) from a consecutive and pooled series of two Novalis® centers and to analyse influence of AVM size, Spetzler-Martin (SM) grade, pre-treatment, and hemorrhagic vs. non-hemorrhagic presentation. A subgroup analysis of ARUBA eligible patients was additionally performed. METHODS: Prospectively collected treatment and outcome data were supplemented by retrospectively collected follow-up (FU) data for 93...
July 13, 2016: World Neurosurgery
Fuxin Lin, Yuming Jiao, Jun Wu, Bing Zhao, Xianzeng Tong, Zhen Jin, Yong Cao, Shuo Wang
OBJECTIVE The impact of functional MRI (fMRI)-guided navigation on the surgical outcome of patients with arteriovenous malformations (AVMs) is undetermined. This large, randomized controlled trial (RCT) was designed to determine the safety and efficacy of fMRI-guided microsurgery of AVMs. This paper reports the preliminary results of the interim analysis. METHODS Between September 2012 and June 2015, eligible patients were randomized to the standard microsurgery group (control group) or the fMRI-guided surgery group (experimental group) in a 1:1 ratio...
July 1, 2016: Journal of Neurosurgery
Vikas Jha, Sanjay Behari, Awadhesh K Jaiswal, Kamlesh Singh Bhaisora, Yogesh P Shende, Rajendra V Phadke
CONTEXT: Concurrent arterial aneurysms (AAs) occurring in 2.7-16.7% patients harboring an arteriovenous malformation (AVM) aggravate the risk of intracranial hemorrhage. AIM: We evaluate the variations of aneurysms simultaneously coexisting with AVMs. A classification-based management strategy and an abbreviated nomenclature that describes their radiological features is also proposed. SETTING: Tertiary care academic institute. STATISTICS: Test of significance applied to determine the factors causing rebleeding in the groups of patients with concurrent AVM and aneurysm and those with only AVMs...
July 2016: Asian Journal of Neurosurgery
Yuming Jiao, Fuxin Lin, Jun Wu, Hao Li, Lijun Wang, Zhen Jin, Shuo Wang, Yong Cao
OBJECTIVE: Temporo-occipital junction arteriovenous malformations (TOJ-AVMs) do not often involve eloquent brain cortex, but rather exist beside functional fiber tracts. The objective of this study was to determine the outcomes after surgical treatment in patients with TOJ-AVMs and to identify risk factors associated with postoperative neurologic deficits. METHODS: We retrospectively studied 41 patients with TOJ-AVMs. All patients underwent preoperative diffusion tensor imaging...
September 2016: World Neurosurgery
Mario K Teo, Adam M H Young, Edward J St George
OBJECTIVES: Microsurgical resection of brain arteriovenous malformation (AVMs) is challenging, however, expert surgical series from large volume centres, have reported over 95% occlusion rates with 2 to 8% risk of morbidity & mortality. Data from a regional neurosurgical unit was analysed and compared with published series for the purposes of quality control. We also compared our surgical result with other treatment modalities from the whole AVM cohort managed over the same study period...
June 24, 2016: British Journal of Neurosurgery
Johannes Schramm, Karl Schaller, Jonas Esche, Azize Boström
OBJECTIVE The objective of this study was to review the outcomes after microsurgical resection of cerebral arteriovenous malformations (AVMs) from a consecutive single-surgeon series. Clinical and imaging data were analyzed to address the following questions concerning AVM treatment in the post-ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) era. 1) Are the patients who present with unruptured or ruptured AVMs doing better at long-term follow-up? 2) Is the differentiation between Ponce Class A (Spetzler-Martin Grade I and II) patients versus Ponce Class B and C patients (Spetzler-Martin Grade III and IV) meaningful and applicable to surgical practice? 3) How did the ARUBA-eligible patients of this surgical series compare with the results reported in ARUBA? METHODS Two hundred eighty-eight patients with cerebral AVMs underwent microsurgical resection between 1983 and 2012 performed by the same surgeon (J...
June 10, 2016: Journal of Neurosurgery
E Magro, J-C Gentric, T E Darsaut, A L Batista, C Chaalala, D Roberge, A Weill, D Roy, M W Bojanowski, J Raymond
OBJECTIVE: The management of unruptured and ruptured brain arteriovenous malformations (AVMs) remains controversial. The Treatment of Brain AVM Study (TOBAS) was designed to assess curative treatments in the management of AVMs. The purpose of our study is to provide a care trial context to brain AVM patients. METHODS: TOBAS is a pragmatic, prospective study including 2 randomized controlled trials and a registry. All AVM patients can be recruited. The preferred management modality will be predetermined prior to randomization by the team based on clinical judgment...
August 2016: Neuro-Chirurgie
Mohsen Javadpour, Rafid Al-Mahfoudh, Paul S Mitchell, Ramez Kirollos
OBJECTIVES: To determine the outcome of microsurgical excision of selected unruptured brain arteriovenous malformations (AVMs), and to compare the results with those of the ARUBA trial. METHODS: Prospective data collection for all patients undergoing microsurgical excision of unruptured brain AVMs by two neurovascular surgeons. Outcome measures similar to those assessed in the ARUBA trial (death and stroke) as well as modified Rankin scores (mRS) at 6 months were assessed...
May 13, 2016: British Journal of Neurosurgery
Bikei Ryu, Tatsuya Ishikawa, Takakazu Kawamata
The Spetzler-Martin (S-M) grading scale was developed to assess the risk of postoperative neurological complications after the surgical treatment of arteriovenous malformations (AVMs) of the brain. Treatment-associated morbidity and poor outcomes are particularly relevant to Grade III AVMs and improving the safety while attaining acceptable cure rates still poses a challenge. A multimodal treatment strategy combining surgery, embolization, and radiosurgery is recommended for S-M Grade III AVMs because of the surgical risk...
May 11, 2016: Neurologia Medico-chirurgica
Marian C Neidert, Michael T Lawton, Marius Mader, Burkhardt Seifert, Antonios Valavanis, Luca Regli, Oliver Bozinov, Jan-Karl Burkhardt
OBJECTIVE: To establish an arteriovenous malformation (AVM) grading score for patients with ruptured AVM and associated intracerebral hemorrhage (ICH) to predict clinical outcome. METHODS: Patient data from January 2006 to December 2013 with newly diagnosed ICH caused by ruptured AVM and a modified Rankin Scale (mRS) score <2 before ICH were included for this analysis. Clinical outcome was dichotomized in favorable (mRS score, 0-2) and unfavorable (mRS score, 3-6) to find predictors for outcome and to establish a new score based on the areas under the receiver-operating characteristic curves (AUROC) at 3 months, 1 year, and at last follow-up (mean, 31 months)...
August 2016: World Neurosurgery
Aqueel H Pabaney, Rushna Ali, Maximillian Kole, Ghaus M Malik
BACKGROUND: Arteriovenous malformations (AVMs) of the corpus callosum (CC) are rare entities. We performed a systematic review of the available literature to better define the natural history, patient characteristics, and treatment options for these lesions. METHODS: A MEDLINE, Google Scholar, and The Cochrane Library search were performed for studies published through June 2015. Data from all eligible studies were used to examine epidemiology, natural history, clinical features, treatment strategies, and outcomes of patients with CC-AVMs...
2016: Surgical Neurology International
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