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Freund BE, Sanchez-Boluarte SS, Blackmon K, Day GS, Lin M, Khan A, Feyissa AM, Middlebrooks EH, Tatum WO. Incidence and risk factors associated with seizures in cerebral amyloid angiopathy. Eur J Neurol 2023; 30:3682-3691. [PMID: 37255322 DOI: 10.1111/ene.15903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral amyloid angiopathy (CAA) is a common cause of intracranial hemorrhage (ICH), which is a risk factor for seizures. The incidence and risk factors of seizures associated with a heterogeneous cohort of CAA patients have not been studied. METHODS We conducted a retrospective study of patients with CAA treated at Mayo Clinic Florida between 1 January 2015 and 1 January 2021. CAA was defined using the modified Boston criteria version 2.0. We analyzed electrophysiological and clinical features, and comorbidities including lobar ICH, nontraumatic cortical/convexity subarachnoid hemorrhage (cSAH), superficial siderosis, and inflammation (CAA with inflammation [CAA-ri]). Cognition and mortality were secondary outcomes. Univariate and multivariate analyses were performed to determine risk of seizures relative to clinical presentation. RESULTS Two hundred eighty-four patients with CAA were identified, with median follow-up of 35.7 months (interquartile range = 13.5-61.3 months). Fifty-six patients (19.7%) had seizures; in 21 (37.5%) patients, seizures were the index feature leading to CAA diagnosis. Seizures were more frequent in females (p = 0.032) and patients with lobar ICH (p = 0.002), cSAH (p = 0.030), superficial siderosis (p < 0.001), and CAA-ri (p = 0.005), and less common in patients with microhemorrhage (p = 0.006). After controlling for age and sex, lobar ICH (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.1-4.2), CAA-ri (OR = 3.8, 95% CI = 1.4-10.3), and superficial siderosis (OR = 3.7, 95% CI = 1.9-7.0) were independently associated with higher odds of incident seizures. CONCLUSIONS Seizures are common in patients with CAA and are independently associated with lobar ICH, CAA-ri, and superficial siderosis. Our results may be applied to optimize clinical monitoring and management for patients with CAA.
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Affiliation(s)
- Brin E Freund
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Karen Blackmon
- Department of Psychology and Psychiatry, Mayo Clinic, Jacksonville, Florida, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Lin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Aafreen Khan
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Erik H Middlebrooks
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - William O Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
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Ming X, Qiuyue W, Yujun L, Guanghai M, Xiancheng C, Hongzhi X. Risk factors of seizure presentation in brain arteriovenous malformation patients and seizure outcomes after single-modality treatments. Int J Neurosci 2023; 133:356-364. [PMID: 33896340 DOI: 10.1080/00207454.2021.1921765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Epileptic seizures are common symptoms in brain arteriovenous malformation patients and seizure control was an important issue in the treatments. This retrospective study attempted to define the risk factors of seizure presentation and to evaluate the effects of treatment modalities on seizure outcomes. METHODS Patients receiving single treatment modality during 2013-2016 years, followed up more than 2 years were recruited. Logistic regression analysis was used to detect independent predictors. The factors associated with seizure control were analyzed in patients with pre-treatment seizures, and the factors associated with de novo seizures were analyzed in patents without pre-treatment seizures. RESULTS Multivariate analysis identified that the independent predictors of seizure presentation were unruptured (ruptured vs. unruptured, OR = 0.314), and in the frontal (frontal vs. parietal, OR = 3.982) or temporal lobe (temporal vs parietal, OR = 3.313). In 47 patients with seizure presentation, good seizure outcomes were achieved in 26 cases. Partial obliteration of nidus (partial vs complete, OR = 32.301) and headache presentation were independent predictors of poor outcome. In 169 patients without seizure presentation, de novo seizures occurred in 22 cases. Treatments of microsurgery or radiosurgery led to a higher incidence of de novo seizures than intravascular embolization. CONCLUSIONS Patients with unruptured and frontal/temporal lobe located nidus were more likely to manifest seizure presentation. Incomplete nidus obliteration was an independent risk factor of poor outcomes in patients with pre-existing seizures. However, compared to microsurgery or radiosurgery, endovascular embolization was less likely to cause de novo seizures in patients without pre-existing seizures.
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Affiliation(s)
- Xu Ming
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wu Qiuyue
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Liao Yujun
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Guanghai
- Department of Neurosurgery, Cyberknife Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Xiancheng
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu Hongzhi
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Bustuchina Vlaicu M. New approaches for brain arteriovenous malformations-related epilepsy. Rev Neurol (Paris) 2023; 179:188-200. [PMID: 36180290 DOI: 10.1016/j.neurol.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/21/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this review is to present the current literature and to highlight the most recent findings in brain arteriovenous malformations (bAVM)-related epilepsy research. METHODS We searched Medline, PubMed, Biblioinserm, Cochrane Central to study the latest research reports about the different factors that could be responsible for the genesis of bAVM-related epilepsy. We analyzed if epileptogenesis has any characteristics traits and its relation with the vascular malformation. The results of different treatments on epilepsy were considered. Typical errors that may lead towards incorrect or worse management of the seizures for these patients were also examined. RESULTS The development of bAVM results from multifactorial etiologies and bAVM-related epileptogenesis is likely specific for this pathology. Different types of evidence demonstrate a bidirectional relationship between bAVM and epilepsy. Currently, there is not enough published data to determine what may be the right management for these patients. CONCLUSIONS A better understanding of epileptogenesis in conjunction with knowledge of the complex alterations of structures and functions following bAVM-related seizures is necessary. Identification of biomarkers that can identify subgroups most likely to benefit from a specific intervention are needed to help guide clinical management. A new concept for the treatment of epilepsy related to an unruptured bAVM that cannot be treated invasively is proposed as well as new therapeutic perspectives. The next necessary step will be to propose additional algorithms to improve the development of future trials.
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Affiliation(s)
- M Bustuchina Vlaicu
- Pitié-Salpêtrière Hospital, Department of Neurosurgery, Paris, France; Inserm U0955, Translational Neuro-Psychiatry team, Créteil, France.
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Effect of Targeted Embolization on Seizure Outcomes in Patients with Brain Arteriovenous Malformations. Diagnostics (Basel) 2022; 13:diagnostics13010047. [PMID: 36611339 PMCID: PMC9818224 DOI: 10.3390/diagnostics13010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Seizures are one of the most debilitating manifestations of brain arteriovenous malformations (AVMs). This study aimed to evaluate the effect of curative embolization on brain AVM patients presenting with seizures. METHODS The records of patients who underwent embolization for brain AVM from January 2012 to December 2020 were evaluated and patients presenting with seizures were interviewed. Patient responses were evaluated according to the International League Against Epilepsy (ILAE) and Engel classifications. Statistical analyses of factors associated with seizure outcomes and complications were performed using ANOVA and Fischer's exact tests. RESULTS The mean age of the participants was 35.2 ± 10.7 years. More than 80% of the patients received no or suboptimal dosages of antiepileptic drugs (AEDs) prior to embolization. Positive seizure dynamics were observed in 50% of the patients post-procedure. A correlation was found between length of seizures in anamnesis and outcomes of both Engel and ILAE score, where shorter length was associated with better outcomes. Post-embolization hemorrhage was associated with initial presentation with hemorrhage. CONCLUSIONS The embolization of brain AVMs had a positive effect on seizure presentation and a relatively low prevalence of complications. However, the results of the study are obscured by inadequate AED treatment received by the patients, which prompts prospective studies on the topic with careful patient selection.
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Guillaumet G, Shotar E, Clarençon F, Sourour NA, Premat K, Lenck S, Dupont S, Jacquens A, Degos V, Boeken T, Nouet A, Carpentier A, Mathon B. Incidence and risk factors of epilepsy following brain arteriovenous malformation rupture in adult patients. J Neurol 2022; 269:6342-6353. [PMID: 35867151 DOI: 10.1007/s00415-022-11286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about incidence, time of onset, clinical presentation, and risk factors of epileptic seizure following brain arteriovenous malformation (bAVM) rupture. METHODS We performed a monocentric retrospective cohort study from January 2003 to March 2021. The main objective of this study was to determine the incidence of seizures after spontaneous bAVM rupture in nonepileptic adult patients and describe the corresponding clinical features. The secondary objective was to identify clinical, radiological, or biological predictors for the occurrence of de novo seizures after bAVM rupture. RESULTS Of the 296 cases of bAVM rupture registered during the study period, 247 nonepileptic patients (male 53%, median age 40) were included in the study. Fifty-nine patients (23.9%) had at least one seizure after bAVM rupture. The use of preventive antiepileptic drugs (10.3 [1.5-74.1]; P = 0.02) and decompressive craniectomy (15.4 [2.0-125]; P < 0.009) were independently associated with the occurrence of epilepsy after the bAVM rupture. The factors independently associated with the absence of any seizure after the rupture were isolated intraventricular hemorrhage (0.3 [0.1-0.99]; P = 0.04) and infratentorial location of the bAVM (0.2 [0.1-0.5]; P = 0.09). The first seizure occurred within the first year or within 5 years in, respectively, 83.1% and 98.3% of the patients. CONCLUSIONS Epilepsy affects nearly a quarter of patients after bAVM rupture. Decompressive craniectomy represents an independent risk factor significantly associated with the occurrence of epilepsy after bAVM rupture. The introduction of preventive AEDs after rupture could be considered in these most severe patients who have a decompressive craniectomy.
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Affiliation(s)
- Gonzague Guillaumet
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France
| | - Eimad Shotar
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Kevin Premat
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Sophie Dupont
- Epileptology Unit, Department of Rehabilitation, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alice Jacquens
- Department of Neurosurgical Anesthesiology and Critical Care, AP-HP, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Vincent Degos
- Department of Neurosurgical Anesthesiology and Critical Care, AP-HP, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Tom Boeken
- Department of Vascular and Oncological Interventional Radiology, AP-HP, Centre, Hôpital Européen Georges-Pompidou, 75015, Paris, France.,Université de Paris, 75006, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France
| | - Alexandre Carpentier
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France
| | - Bertrand Mathon
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France. .,ICM, INSERM U 1127, CNRS UMR 7225, UMRS 1127, Paris Brain Institute, Sorbonne University, 75013, Paris, France.
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Lak AM, Cerecedo-Lopez CD, Cha J, Aziz-Sultan MA, Frerichs KU, Gormley WB, Mekary RA, Du R, Patel NJ. Seizure Outcomes After Interventional Treatment in Cerebral Arteriovenous Malformation-Associated Epilepsy: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 160:e9-e22. [PMID: 35364673 DOI: 10.1016/j.wneu.2021.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seizures are the second most common presenting symptom of cerebral arteriovenous malformations (AVMs). Evidence supporting different treatment modalities is continuously evolving and it remains unclear which modality offers better seizure outcomes. OBJECTIVE To compare various interventional treatment modalities (i.e., microsurgery, radiosurgery, endovascular embolization, or multimodality treatment), regarding outcomes in AVM-associated epilepsy. METHODS PubMed, Embase, and Web of Science were searched on December 31, 2020 for studies that evaluated outcomes in patients with AVM-associated epilepsy after undergoing different treatment modalities. Pooled analysis was performed using a random-effects model and stratified by different modalities. RESULTS Forty-nine studies including 2668 patients were included. Interventional management was associated with a 56.0% probability of seizure freedom and a 73.0% probability of seizure improvement. The probability of discontinuing antiepileptic drugs was estimated at 38.0%. The stratified analysis showed that microsurgery was associated with a higher probability of seizure freedom and seizure improvement than was radiosurgery, endovascular, or multimodality treatment. The probability of antiepileptic drug cessation was also higher after microsurgery compared with radiation therapy; however, only clinical but not statistical significance could be inferred because of the lack of comparative analyses. CONCLUSIONS Interventional management of AVM-related epilepsy was associated with seizure freedom and seizure improvement in 56% and 73% of cases. Microsurgery seemed to be associated with a higher incidence of seizure freedom and seizure improvement than did other modalities. Future well-designed comparative studies are needed to draw definitive conclusions regarding each modality.
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Affiliation(s)
- Asad M Lak
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian D Cerecedo-Lopez
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Cha
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohammad Ali Aziz-Sultan
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai U Frerichs
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William B Gormley
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rania A Mekary
- Computational Neurosciences Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav J Patel
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Khumtong R, Katawatee K, Amornpojnimman T, Riabroi K, Sungkaro K, Korathanakhun P. Predictors of seizure control in patients with cerebral arteriovenous malformation. Epilepsy Behav 2022; 128:108575. [PMID: 35123239 DOI: 10.1016/j.yebeh.2022.108575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We aimed to define the predictors of a 2-year seizure-free outcome among patients with cerebral arteriovenous malformation (AVM). METHODS A retrospective cohort study recruited patients diagnosed with AVM admitted in the hospital between 2002 and 2020. The demographic data, clinical presentations, seizure semiology, neuro-imaging findings, modality of treatment, and clinical outcomes were compared between the 2-year seizure-free and non-2-year seizure-free groups. A logistic regression model was applied to determine the significant predictors of a 2-year seizure-free outcome. RESULTS Of 372 radiologically confirmed patients with cerebral AVM, 105 (28.23%) experienced seizure and a 2-year seizure-free outcome was achieved in 76.19%. Most seizures presented as the initial symptom. Generalized onset seizure was the most common seizure semiology. A nidus diameter < 3 cm (adjusted odds ratio [aOR] 3.102; 95% CI 1.129-9.683; p = 0.046) was the independent predictor of a 2-year seizure-free period, whereas underlying epilepsy (aOR 0.141; 95% CI 0.010-0.688; p = 0.015) was an independent predictor against a 2-year seizure-free outcome. CONCLUSION A nidus diameter < 3 cm was the independent predictor of a 2-year seizure-free outcome, whereas underlying epilepsy was the factor against a 2-year seizure-free outcome.
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Affiliation(s)
- Rujimas Khumtong
- Neurointerventional Radiology Unit, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kesinee Katawatee
- Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Thanyalak Amornpojnimman
- Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kittipong Riabroi
- Neurointerventional Radiology Unit, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kanisorn Sungkaro
- Neurosurgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Pat Korathanakhun
- Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Thailand.
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Arteriovenous Malformations and Other Vascular Anomalies. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Capocci R, Bustuchina Vlaicu M, Shotar E, Mathon B, Delaitre M, Premat K, Talaat M, Talbi A, Boch AL, Lenck S, Carpentier A, Degos V, Sourour NA, Clarençon F. Benefits from Exclusion Treatment of Unruptured Brain Arteriovenous Malformations on Epilepsy in Adults. Clin Neuroradiol 2021; 32:749-760. [PMID: 34807285 DOI: 10.1007/s00062-021-01119-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In approximately 30% of the patients, brain arteriovenous malformations (bAVMs) are revealed by seizures, which may alter the patients' quality of life. Our objective was to evaluate the benefits of exclusion treatment (radiosurgery, embolization and/or surgery) on posttherapeutic epilepsy in bAVM patients without intracranial hemorrhage prior to treatment. METHODS Our retrospective observational single-center study included all consecutive adult patients with an unruptured bAVM and epilepsy, treated at our institution from 1995 to 2019 and who were followed for at least 1 year. Data on angioarchitectural characteristics of bAVMs, on epilepsy and posttreatment modified Rankin Scale (mRS) were collected. The primary endpoint was a seizure-free status (defined as Engel class IA) after exclusion treatment versus conservative management. RESULTS In this study one hundred and one consecutive adult patients with bAVMs, epilepsy and without bAVM rupture before any treatment were included; 21 (21%) in the conservative management group vs. 80 (79%) in the exclusion treatment group. After exclusion treatment, 55% of the patients from the group were Engel IA after treatment vs. 10% of the conservative management group (odds ratio [OR] 11.37, 95% confidence interval [CI] 2.48-107.24, p < 0.001). CONCLUSION Our results suggest that exclusion treatment in unruptured bAVMs with epilepsy is associated with a higher seizure-free rate in comparison with conservative management. Data from randomized controlled studies are necessary to confirm these findings.
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Affiliation(s)
- Romain Capocci
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | | | - Eimad Shotar
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Bertrand Mathon
- Department of Neurosurgery, Pitie-Salpêtrière Hospital, Paris, France.,Sorbonne University Medical School, Paris, France
| | | | - Kévin Premat
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne University Medical School, Paris, France
| | - Maichael Talaat
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Department of Radiology, Zagazig University Hospital, Zagazig, Egypt
| | - Atika Talbi
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Pitie-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, Pitie-Salpêtrière Hospital, Paris, France.,Sorbonne University Medical School, Paris, France
| | - Vincent Degos
- Sorbonne University Medical School, Paris, France.,Department of Neuro-Intensive Care, Pitie-Salpêtrière Hospital, Paris, France.,GRC BioFast. Paris VI University, Paris, France
| | - Nader Antoine Sourour
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. .,Sorbonne University Medical School, Paris, France. .,GRC BioFast. Paris VI University, Paris, France.
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10
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Prablek M, LoPresti MA, Du R, Lam S. Arteriovenous Malformations-Associated Epilepsy in Pediatrics. Childs Nerv Syst 2021; 37:2261-2268. [PMID: 33895871 DOI: 10.1007/s00381-021-05170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Seizures are the second most common presentation of cerebral arteriovenous malformations (AVMs); pediatric patients are more likely to develop AVM-associated epilepsy. We examined the role of multimodality AVM treatment in pediatric AVM-associated epilepsy to characterize long-term epilepsy outcomes. METHODS A retrospective chart review identified pediatric patients with AVM-associated epilepsy seen at our institution from 2005 to 2018. Variables measured included demographic and descriptive data. Primary outcomes included seizure freedom, seizure control, and functional outcomes. RESULTS Of 105 pediatric patients with AVMs, 18 had AVM-related epilepsy. Thirteen underwent surgical resection, of which 6 underwent preoperative embolization. Twelve (92.31%) had complete resection; one (7.69%) with residual underwent redo craniotomy with subsequent complete resection. All had radiographic cure at most recent follow-up, with no recurrence seen during length of follow-up (mean 2.17 years, SD 1.40, range 0.25-4.41). Eight (61.54%) experienced seizure freedom postoperatively; 12 (92.31%) were modified Engel Class I at last follow-up. Five patients underwent treatment without open surgical resection, with conservative management (3, 60%) or endovascular embolization (2, 40%). None in our cohort underwent radiosurgery. Of those embolized, one had complete AVM obliteration and two had partial obliteration. Four of the 5 patients (80%) treated without open surgery achieved seizure freedom. CONCLUSION Long-term outcomes of AVM-related epilepsy are poorly characterized in children. We found that in addition to improved AVM outcomes regarding obliteration, treatment of residual, and recurrence, pediatric patients undergoing surgical AVM treatment had improved AVM-associated epilepsy outcomes, with 61.54% achieving seizure freedom and 92.31% classified as modified Engel Class I seizure control.
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Affiliation(s)
- Marc Prablek
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, 7200 Cambridge Ave, Suite 9A, Houston, TX, 77030, USA.
| | - Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, 7200 Cambridge Ave, Suite 9A, Houston, TX, 77030, USA
| | - Rebecca Du
- Department of Neurosurgery, Northwestern University School of Medicine, Lurie Children's Hospital, Chicago, IL, USA
| | - Sandi Lam
- Department of Neurosurgery, Northwestern University School of Medicine, Lurie Children's Hospital, Chicago, IL, USA
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Wang M, Jiao Y, Zeng C, Zhang C, He Q, Yang Y, Tu W, Qiu H, Shi H, Zhang D, Kang D, Wang S, Liu AL, Jiang W, Cao Y, Zhao J. Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas. Front Neurol 2021; 12:651663. [PMID: 34177760 PMCID: PMC8219979 DOI: 10.3389/fneur.2021.651663] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of this guideline is to present current and comprehensive recommendations for the management of brain arteriovenous malformations (bAVMs) located in eloquent areas. Methods: An extended literature search on MEDLINE was performed between Jan 1970 and May 2020. Eloquence-related literature was further screened and interpreted in different subcategories of this guideline. The writing group discussed narrative text and recommendations through group meetings and online video conferences. Recommendations followed the Applying Classification of Recommendations and Level of Evidence proposed by the American Heart Association/American Stroke Association. Prerelease review of the draft guideline was performed by four expert peer reviewers and by the members of Chinese Stroke Association. Results: In total, 809 out of 2,493 publications were identified to be related to eloquent structure or neurological functions of bAVMs. Three-hundred and forty-one publications were comprehensively interpreted and cited by this guideline. Evidence-based guidelines were presented for the clinical evaluation and treatment of bAVMs with eloquence involved. Topics focused on neuroanatomy of activated eloquent structure, functional neuroimaging, neurological assessment, indication, and recommendations of different therapeutic managements. Fifty-nine recommendations were summarized, including 20 in Class I, 30 in Class IIa, 9 in Class IIb, and 2 in Class III. Conclusions: The management of eloquent bAVMs remains challenging. With the evolutionary understanding of eloquent areas, the guideline highlights the assessment of eloquent bAVMs, and a strategy for decision-making in the management of eloquent bAVMs.
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Affiliation(s)
- Mingze Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuming Jiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Chaofan Zeng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Chaoqi Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Wenjun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hancheng Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Huaizhang Shi
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - A-Li Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Gamma Knife Center, Beijing Neurosurgical Institute, Beijing, China
| | - Weijian Jiang
- Department of Vascular Neurosurgery, Chinese People's Liberation Army Rocket Army Characteristic Medical Center, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
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12
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Eliava S, Gorozhanin V, Shekhtman O, Pilipenko Y, Kuchina O. Surgical Treatment of Unruptured Brain AVMs: Short- and Long-Term Results. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 132:87-90. [PMID: 33973034 DOI: 10.1007/978-3-030-63453-7_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Unruptured brain AVMs (bAVMs) remain a controversial subject for practicing neurosurgeons, especially in the light of ARUBA and other observational studies. This retrospective study aims to analyze our experience with unruptured bAVMs to see whether it is beneficial in the long-term and how it corresponds to large literature trials. The study comprised 160 adult patients with unruptured bAVMs surgically treated in Burdenko NMC (Moscow) in 2009-2017. Mean age: 33.4 ± 10лет. Clinical presentations were: seizures in 99 (61.9%), chronical headaches-49 (30.6%), ischemic symptoms-4 (2.5%), asymptomatic in 8 (5%) patients. Spetzler-Martin scale: I-18 pt. (11.3%), II-71 pt. (44.4%), III-60 pt. (37.5%), IV-11 pt. (6.8%). Good outcomes (mRS = 0-2) at discharge were achieved in 149 (93.1%), satisfactory (mRS-3)-9 (5.6%). Follow-up was complete for 97 (60.6%) patients, mean-59.3 (13-108 month). Excellent outcomes (mRS = 0-1) reached in 94.8%. For epilepsy patients, Engel I outcome was found in 50 (84.8%); for chronic headaches, 43 (66.1%) patients reported improvement. Postoperative visual field defects were followed in 22 of 55 (40%), complete recovery was reported in 6 (27%) and partial recovery in 8 (36%) patients. Overall, our results support the conclusion that surgery for low-grade bAVMs (S-M I-II) is a beneficial, low-risk option.
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Affiliation(s)
- Shalva Eliava
- National Medical Research Center "Burdenko Neurosurgical Institute", Moscow, Russia.
| | - Vadim Gorozhanin
- National Medical Research Center "Burdenko Neurosurgical Institute", Moscow, Russia
| | - Oleg Shekhtman
- National Medical Research Center "Burdenko Neurosurgical Institute", Moscow, Russia
| | - Yuri Pilipenko
- National Medical Research Center "Burdenko Neurosurgical Institute", Moscow, Russia
| | - Olga Kuchina
- National Medical Research Center "Burdenko Neurosurgical Institute", Moscow, Russia
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13
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Florian IA, Popovici L, Timis TL, Florian IS, Berindan-Neagoe I. Intracranial Gorgon: Surgical Case Report of a Large Calcified Brain Arteriovenous Malformation. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922872. [PMID: 32341328 PMCID: PMC7200094 DOI: 10.12659/ajcr.922872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 55-year-old Final Diagnosis: Right frontal arteriovenous malformation, partially calcified • multiple generalised epileptic seizures • chronic headache Symptoms: Epilectic seizure • headache Medication: — Clinical Procedure: Neurosurgical resection of the right frontal AVM Specialty: Neurosurgery
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Affiliation(s)
- Ioan Alexandru Florian
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania.,Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Laura Popovici
- Department of General Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Larisa Timis
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Stefan Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Berindan-Neagoe
- MEDFUTURE Research Center for Advanced Medicine, Cluj-Napoca, Romania.,Research Center for Functional Genomics, Biomedicine, and Translational Medicine, Institute of Doctoral Studies, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Experimental Pathology, "Prof. Ion Chiricuta", The Oncology Institute, Cluj-Napoca, Romania
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14
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Unnithan AKA. Overview of the current concepts in the management of arteriovenous malformations of the brain. Postgrad Med J 2020; 96:212-220. [DOI: 10.1136/postgradmedj-2019-137202] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/12/2019] [Accepted: 01/11/2020] [Indexed: 12/12/2022]
Abstract
BackgroundThere is a lack of consensus in the management of arteriovenous malformations (AVMs) of the brain since ARUBA (A Randomised trial of Unruptured Brain Arteriovenous malformations) trial showed that medical management is superior to interventional therapy in patients with unruptured brain AVMs. The treatment of brain AVM is associated with significant morbidity.Objectives and methodsA review was done to determine the behaviour of brain AVMs and analyse the risks and benefits of the available treatment options. A search was done in the literature for studies on brain AVMs. Descriptive analysis was also done.ResultsThe angiogenic factors such as vascular endothelial growth factor and inflammatory cytokines are involved in the growth of AVMs. Proteinases such as matrix metalloproteinase-9 contribute to the weakening and rupture of the nidus. The risk factors for haemorrhage are prior haemorrhage, deep and infratentorial AVM location, exclusive deep venous drainage and associated aneurysms. The advancements in operating microscope and surgical techniques have facilitated microsurgery. Stereotactic radiosurgery causes progressive vessel obliteration over 2–3 years. Endovascular embolisation can be done prior to microsurgery or radiosurgery and for palliation.ConclusionsSpetzler-Martin grades I and II have low surgical risks. The AVMs located in the cerebellum, subarachnoid cisterns and pial surfaces of the brainstem can be treated surgically. Radiosurgery is preferable for deep-seated AVMs. A combination of microsurgery, embolisation and radiosurgery is recommended for deep-seated and Spetzler-Martin grade III AVMs. Observation is recommended for grades IV and V.
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15
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Niranjan A, Kashkoush A, Kano H, Monaco EA, Flickinger JC, Lunsford LD. Seizure control after radiosurgery for cerebral arteriovenous malformations: a 25-year experience. J Neurosurg 2019; 131:1763-1772. [PMID: 30554186 DOI: 10.3171/2018.7.jns18304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Seizures are the second-most common presenting symptom in patients with lobar arteriovenous malformations (AVMs). However, few studies have assessed the long-term effect of stereotactic radiosurgery (SRS) on seizure control. The authors of this study assess the outcome of SRS for these patients to identify prognostic factors associated with seizure control. METHODS Patients with AVM who presented with a history of seizure and underwent SRS at the authors' institution between 1987 and 2012 were retrospectively assessed. The total cohort included 155 patients with a mean follow-up of 86 months (range 6-295 months). Primary outcomes assessed were seizure frequency, antiepileptic drug regimen, and seizure freedom for 6 months prior to last follow-up. RESULTS Seizure-free status was achieved in 108 patients (70%), with an additional 23 patients (15%) reporting improved seizure frequency as compared to their pre-SRS status. The median time to seizure-free status was estimated to be 12 months (95% CI 0-27 months) as evaluated via Kaplan-Meier survival analysis. The mean seizure frequency prior to SRS was 14.2 (95% CI 5.4-23.1) episodes per year. Although not all patients tried, the proportion of patients successfully weaned off all antiepileptic drugs was 18% (28/155 patients). On multivariate logistic regression, focal impaired awareness seizure type (also known as complex partial seizures) and superficial venous drainage were significantly associated with a decreased odds ratio for seizure-free status at last follow-up (OR 0.37 [95% CI 0.15-0.92] for focal impaired awareness seizures; OR 0.36 [95% CI 0.16-0.81] for superficial venous drainage). The effects of superficial venous drainage on seizure outcome were nonsignificant when excluding patients with < 2 years of follow-up. AVM obliteration did not correlate with long-term seizure freedom (p = 0.202, chi-square test). CONCLUSIONS This study suggests that SRS improves long-term seizure control and increases the likelihood of being medication free, independently of AVM obliteration. Patients with focal impaired awareness seizures were less likely to obtain long-term seizure relief.
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16
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Tadevosyan AR, Sysoev KV, Samochernykh KA, Khachatryan VA. [Arteriovenous malformations and epileptic seizures in children: risk factors of seizures and efficacy of their control depending on the surgical treatment modality]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:83-89. [PMID: 30900691 DOI: 10.17116/neiro2019830117583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epileptic seizures are some of the most frequent manifestations of cerebral AVMs in children. Poor control of seizures can significantly affect patients' quality of life. In this case, factors that are associated with the development of seizures and affect the efficacy of their control upon treatment of cerebral AVMs are not well understood. PURPOSE The purpose of this study was to identify risk factors for the development of epileptic seizures as well as factors associated with a seizure-free outcome of AVM treatment in children. MATERIAL AND METHODS We analyzed the results of examination and treatment in 89 patients with cerebral AVMs aged 1 to 17 years. RESULTS Factors associated with the development of epileptic seizures in cerebral AVMs in children included male gender of the child, a large size of AVM and its superficial location, as well as localization of the pathology in the frontal and temporal lobes of the brain and draining varices. Regression of seizures after surgery was more often observed in the case of microsurgical and/or complex surgical treatment and complete exclusion of the AVM as well as in cases of rare attacks and a short course of the disease. CONCLUSION Complex and microsurgical treatment of AVMs in children provides effective control of epileptic seizures, which is obviously associated with complete exclusion of the AVM and removal of the epileptic focus located near the AVM.
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Affiliation(s)
- A R Tadevosyan
- Almazov National Medical Research Center, Saint Petersburg, Russia
| | - K V Sysoev
- Almazov National Medical Research Center, Saint Petersburg, Russia
| | - K A Samochernykh
- Almazov National Medical Research Center, Saint Petersburg, Russia
| | - V A Khachatryan
- Almazov National Medical Research Center, Saint Petersburg, Russia
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17
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Gorozhanin VA, Eliava SS, Pilipenko YV, Shekhtman OD, Sazonova OB. [Immediate outcomes of microsurgical treatment of cerebral arteriovenous malformations in non-hemorrhagic patients]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 82:30-37. [PMID: 30721215 DOI: 10.17116/neiro20188206130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Arteriovenous malformations (AVMs) are some of the most frequent congenital abnormalities of the cerebral vascular system and usually occur at a young age. Given the fact that AVMs can manifest, in addition to hemorrhages, as symptomatic epilepsy (17-40%) that occurs more often at a young age and may lead to significant disability, investigation of this pathology remains topical. Particular attention has recently been paid to the management of AVM patients without clinical signs of hemorrhage at the time of pathology diagnosis. OBJECTIVE The objective of this study was to optimize the management of patients with unruptured AVMs based on analysis of the immediate outcomes of microsurgical treatment. MATERIAL AND METHODS We retrospectively analyzed the immediate outcomes of microsurgical treatment of AVM patients hospitalized to the Burdenko Neurosurgical Institute in the period from 2009 to 2017. The patients included in the study met the following criteria: age over 18 years; microsurgical resection of AVM. The main exclusion criterion was a hemorrhage history confirmed by clinical data or verified by a neuroimaging study (MRI/CT). The study included 160 patients (58.1% males and 41.9% females) aged 18 to 67 years (mean, 33.5 years). According to the clinical course, patients with epileptic syndrome prevailed: 99 (61.9%) cases. Headaches occurred in 49 (30.6%) patients; 8 (5%) patients had asymptomatic AVMs; 4 (2.5%) patients had ischemic stroke. The surgical risk was assessed by using the Spetzler-Martin (S-M) scale: Grade I - 18 (11.3%) patients, Grade II - 71 (44.4%) patients, Grade III - 60 (37.5%) patients, and Grade IV - 11 (6.8%) patients. Direct surgery in patients with AVMs classified as S-M V was not planned. RESULTS Postoperative analysis revealed that 33 patients included in the study group in accordance with the above criteria had silent AVM hemorrhage that was confirmed only based on the intraoperative picture. The best surgical treatment outcomes were observed in patients with S-M I and II AVMs. The outcome scored 4 and 5 on the Glasgow Outcome Scale (GOS) was in 100% of cases in the S-M I group, 98.6% in the S-M II group, 86.7% in the S-M III group, and 81.8% in the S-M IV group. The relatively good outcomes of S-M IV AVM resection are explained by careful selection of patients for surgery. In general, good postoperative outcomes (GOS score of 4 and 5) were in 93.2% of patients. The main newly developed postoperative symptoms were visual impairments - visual field defects (64.7% of all complications). Postoperative mortality was 1.3%. CONCLUSION Surgical treatment is indicated for patients with unruptured AVMs and S-M I or II surgical risk, regardless of clinical manifestations. In other cases, the treatment approach depends on a number of risk factors.
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Affiliation(s)
| | - Sh Sh Eliava
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - O B Sazonova
- Burdenko Neurosurgical Institute, Moscow, Russia
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18
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Ironside N, Chen CJ, Ding D, Ilyas A, Kumar JS, Buell TJ, Taylor D, Lee CC, Sheehan JP. Seizure Outcomes After Radiosurgery for Cerebral Arteriovenous Malformations: An Updated Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:550-562.e3. [DOI: 10.1016/j.wneu.2018.08.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/30/2022]
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19
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Yang H, Deng Z, Yang W, Liu K, Yao H, Tong X, Wu J, Zhao Y, Cao Y, Wang S. Predictive Factors of Postoperative Seizure for Pediatric Patients with Unruptured Arteriovenous Malformations. World Neurosurg 2017; 105:37-46. [DOI: 10.1016/j.wneu.2017.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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20
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Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, Torner JC. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2017. [DOI: 10.1161/str.0000000000000134] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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O’Donnell JM, Morgan MK, Heller GZ. The Risk of Seizure Following Surgery for Brain Arteriovenous Malformation: A Prospective Cohort Study. Neurosurgery 2017; 81:935-948. [DOI: 10.1093/neuros/nyx101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/15/2017] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
The evidence for the risk of seizures following surgery for brain arteriovenous malformations (bAVM) is limited.
OBJECTIVE
To determine the risk of seizures after discharge from surgery for supratentorial bAVM.
METHODS
A prospectively collected cohort database of 559 supratentorial bAVM patients (excluding patients where surgery was not performed with the primary intention of treating the bAVM) was analyzed. Cox proportional hazards regression models (Cox regression) were generated assessing risk factors, a Receiver Operator Characteristic curve was generated to identify a cut-point for size and Kaplan–Meier life table curves created to identify the cumulative freedom from postoperative seizure.
RESULTS
Preoperative histories of more than 2 seizures and increasing maximum diameter (size, cm) of bAVM were found to be significantly (P < .01) associated with the development of postoperative seizures and remained significant in the Cox regression (size as continuous variable: P = .01; hazard ratio: 1.2; 95% confidence interval: 1.0-1.3; more than 2 seizures: P = .02; hazard ratio: 2.1; 95% confidence interval: 1.1-3.8). The cumulative risk of first seizure after discharge from hospital following resection surgery for all patients with bAVM was 5.8% and 18% at 12 mo and 7 yr, respectively. The 7-yr risk of developing postoperative seizures ranged from 11% for patients with bAVM ≤4 cm and with 0 to 2 preoperative seizures, to 59% for patients with bAVM >4 cm and with >2 preoperative.
CONCLUSION
The risk of seizures after discharge from hospital following surgery for bAVM increases with the maximum diameter of the bAVM and a patient history of more than 2 preoperative seizures.
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Affiliation(s)
| | | | - Gillian Z Heller
- Department of Statistics, Macquarie University, Sydney NSW, Australia
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22
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Abstract
Various types of seizures and epilepsy are associated with 20-45% of cerebral arteriovenous malformations (AVMs). The necessity to differentiate between occasional seizures, epilepsy with repetitive seizures, and the much rarer drug-resistant epilepsy (DRE) is underlined. It is clear that where there is frequent seizures or DRE, vascular surgeons should take epilepsy surgery aspects into account. The epidemiology of AVM-associated seizures, assumed pathophysiologic mechanisms, most frequent seizures types, and medical treatment are described. Depending on the severity of the epilepsy, the diagnostic workup, including electroencephalogram (EEG), video-EEG, and, rarely, invasive evaluation, is explained. An invasive presurgical workup is only necessary in rare cases of DRE. The indication to extend the resection to more than just removal of the AVM is defined and the various specific resection techniques for this rare form are outlined. In the vast majority of AVM cases removal of the AVM with some adjoining gliotic or hemosiderotic rim of cortex will be sufficient, however. In the majority of cases with preoperative epilepsy, patients will be seizure-free after surgery. Patients who never had a seizure before AVM removal may develop de novo epilepsy postoperatively (5-15%). Rates of seizure freedom after different treatments (microsurgery, radiosurgery, endovascular) vary.
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Tong X, Wu J, Cao Y, Zhao Y, Wang S, Zhao J. Microsurgical Outcome of Unruptured Brain Arteriovenous Malformations: A Single-Center Experience. World Neurosurg 2016; 99:644-655. [PMID: 28042014 DOI: 10.1016/j.wneu.2016.12.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We describe our single-center experience treating unruptured brain arteriovenous malformations (uBAVMs) with microsurgical treatment. METHODS During a 7-year period, 282 patients with uBAVMs were surgically treated at our institution. Patient clinical features, postsurgical complications, arteriovenous malformation obliteration rate, seizure control, and functional outcome were collected and analyzed. Seizure control was evaluated with the Engel classification system. Patient functional outcome was assessed with modified Rankin Scale score. RESULTS Complete obliteration was achieved in 98.2% of cases. Surgical mortality rate was zero, and overall mortality rate was 1.1%. Good functional outcome (modified Rankin Scale score 0-1) was achieved in 86.9% of all patients, including 92.5% of patients with Spetzler-Martin (S-M) grade I and II uBAVMs, 80.6% of patients with S-M grade III uBAVMs, and 62.5% of patients with S-M grade IV and V uBAVMs. Poor outcome was significantly associated with arteriovenous malformation size ≥6 cm, deep venous drainage, eloquent location, and poor seizure control (all P < 0.05). For 177 patients with presurgical seizures, good seizure outcome (Engel class I) was achieved in 124 (70.1%) patients after microsurgical treatment. A short history of seizure occurrence, fewer presurgical seizures, and generalized tonic-clonic seizure type may be predictors of good seizure outcome (all P < 0.05). CONCLUSIONS Good functional outcome can be achieved by microsurgical resection in S-M grade I and II and selected grade III uBAVMs. Surgical resection for high-grade (grade IV and V) uBAVMs is challenging. A high seizure-free rate can be achieved in patients with initial seizure presentation.
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Affiliation(s)
- Xianzeng Tong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China.
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
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Ma X, Tong X, Wu J, Cao Y, Wang S. Seizure control following treatment of brain arteriovenous malformations in pediatric patients. Childs Nerv Syst 2016; 32:2387-2394. [PMID: 27585993 DOI: 10.1007/s00381-016-3216-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/03/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Seizure outcome after treatment for pediatric patients with arteriovenous malformations (AVMs) has been rarely described in the literature. The aim of this study was to determine the risk factors for seizure presentation in pediatric AVM patients and the predictors for seizure control following treatment. METHODS We searched our characteristics of seizures associated with brain arteriovenous malformations prospectively maintained AVM database at Beijing Tiantan Hospital and identified 198 pediatric patients with brain AVMs between the year 2009 and 2014. Seizure presentation, patient characteristics, AVM features, treatment modalities, and postoperative outcomes, especially post-treatment seizure control were collected. Univariate and multivariate logistic regression analyses were applied to determine the risk factors for seizure presentation as well as the predictors for seizure control. RESULTS Before initiation of any treatments, 63 (31.8 %) of the overall 198 patients presented with seizure. According to multivariate analyses, larger AVM size, frontal AVM location, and history of prior hemorrhage were significantly associated with seizure presentation (all p < 0.05). For patients with pre-treatment seizure presentation, good seizure outcome was achieved in 73.8 %. AVM obliteration, short-period history of seizure, and short duration for seizure onset were independent predictors of good seizure outcome in the multivariate analysis. For the 135 patients without seizures at presentation, the overall rate of de novo seizures was 4.4 %. CONCLUSION In pediatric patients with brain AVMs, prior hemorrhage, larger AVM size, and frontal lobe location may predict subsequent seizures. Highest seizure control can be achieved by complete obliteration of the AVMs with microsurgical resection.
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Affiliation(s)
- Xiangke Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
- China National Clinical Research Center For Neurological Diseases, Beijing, 100050, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100050, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100050, People's Republic of China
| | - Xianzeng Tong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
- China National Clinical Research Center For Neurological Diseases, Beijing, 100050, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100050, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100050, People's Republic of China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
- China National Clinical Research Center For Neurological Diseases, Beijing, 100050, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100050, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100050, People's Republic of China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
- China National Clinical Research Center For Neurological Diseases, Beijing, 100050, People's Republic of China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100050, People's Republic of China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100050, People's Republic of China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.
- China National Clinical Research Center For Neurological Diseases, Beijing, 100050, People's Republic of China.
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100050, People's Republic of China.
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, 100050, People's Republic of China.
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Relief of epilepsy and headache and quality of life after microsurgical treatment of unruptured brain AVM—audit of a single-center series and comprehensive review of the literature. Neurosurg Rev 2016; 40:59-65. [DOI: 10.1007/s10143-016-0750-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/29/2016] [Accepted: 04/09/2016] [Indexed: 10/21/2022]
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Ferlisi M, Zanoni T, Moretto G, Pasqualin A. Seizures and Brain Arterovenous Malformation: A Surgical Series. ACTA NEUROCHIRURGICA SUPPLEMENT 2016; 123:147-51. [DOI: 10.1007/978-3-319-29887-0_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Josephson CB, Sauro K, Wiebe S, Clement F, Jette N. Medical vs. invasive therapy in AVM-related epilepsy: Systematic review and meta-analysis. Neurology 2015; 86:64-71. [PMID: 26643547 DOI: 10.1212/wnl.0000000000002240] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/27/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare invasive arteriovenous malformation (AVM) therapy to conservative management using only antiepileptic drugs (AEDs) for achieving seizure freedom in patients with AVM-related epilepsy. METHODS We searched Medline, Embase, and Cochrane Central up to June 2015 using epilepsy and AVM Medical Subject Headings and keywords. We included original research involving controlled observational cohort studies or randomized controlled trials (RCTs) comparing seizure outcomes between invasive AVM treatments vs. AED management alone, and uncontrolled case series of invasive AVM therapy for seizures that contained ≥20 patients. The estimates of seizure freedom were pooled using meta-analysis for the controlled trials, while the estimates for the case series were evaluated using descriptive statistics. RESULTS Of 2,166 identified abstracts, 98 were reviewed in full text, of which 31 were included in the final dataset. We identified 2 controlled observational studies (n = 106 patients) and 29 uncontrolled case series. We identified 1 RCT but it did not report seizure outcomes. The pooled risk ratio for seizure freedom in controlled studies (0.99; 95% confidence interval [CI] 0.69, 1.43) did not indicate superiority to either approach. Seizure freedom in case series varied from 19% (95% CI 11, 30%) to 95% (95% CI 76, 99%) at last follow-up. CONCLUSIONS There is insufficient evidence available to determine if invasive AVM management is superior to AED only for controlling seizures. An RCT of interventional vs. medical management using standardized epilepsy-specific presurgical protocols is warranted.
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Affiliation(s)
- Colin B Josephson
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada
| | - Khara Sauro
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada
| | - Samuel Wiebe
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada
| | - Fiona Clement
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada
| | - Nathalie Jette
- From the Department of Clinical Neurosciences and Hotchkiss Brain Institute (C.B.J., S.W., N.J.) and the Department of Community Health Sciences and O'Brien Institute for Public Health (C.B.J., K.S., S.W., F.C., N.J.), University of Calgary, Canada.
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Ding D, Quigg M, Starke RM, Xu Z, Yen CP, Przybylowski CJ, Dodson BK, Sheehan JP. Radiosurgery for temporal lobe arteriovenous malformations: effect of temporal location on seizure outcomes. J Neurosurg 2015; 123:924-34. [DOI: 10.3171/2014.10.jns141807] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The temporal lobe is particularly susceptible to epileptogenesis. However, the routine use of anticonvulsant therapy is not implemented in temporal lobe AVM patients without seizures at presentation. The goals of this case-control study were to determine the radiosurgical outcomes for temporal lobe AVMs and to define the effect of temporal lobe location on postradiosurgery AVM seizure outcomes.
METHODS
From a database of approximately 1400 patients, the authors generated a case cohort from patients with temporal lobe AVMs with at least 2 years follow-up or obliteration. A control cohort with similar baseline AVM characteristics was generated, blinded to outcome, from patients with non-temporal, cortical AVMs. They evaluated the rates and predictors of seizure freedom or decreased seizure frequency in patients with seizures or de novo seizures in those without seizures.
RESULTS
A total of 175 temporal lobe AVMs were identified based on the inclusion criteria. Seizure was the presenting symptom in 38% of patients. The median AVM volume was 3.3 cm3, and the Spetzler-Martin grade was III or higher in 39% of cases. The median radiosurgical prescription dose was 22 Gy. At a median clinical follow-up of 73 months, the rates of seizure control and de novo seizures were 62% and 2%, respectively. Prior embolization (p = 0.023) and lower radiosurgical dose (p = 0.027) were significant predictors of seizure control. Neither temporal lobe location (p = 0.187) nor obliteration (p = 0.522) affected seizure outcomes. The cumulative obliteration rate was 63%, which was significantly higher in patients without seizures at presentation (p = 0.046). The rates of symptomatic and permanent radiation-induced changes were 3% and 1%, respectively. The annual risk of postradiosurgery hemorrhage was 1.3%.
CONCLUSIONS
Radiosurgery is an effective treatment for temporal lobe AVMs. Furthermore, radiosurgery is protective against seizure progression in patients with temporal lobe AVM–associated seizures. Temporal lobe location does not affect radiosurgery-induced seizure control. The low risk of new-onset seizures in patients with temporal or extratemporal AVMs does not seem to warrant prophylactic use of anticonvulsants.
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Affiliation(s)
- Dale Ding
- Departments of 1Neurological Surgery and
| | - Mark Quigg
- 2Neurology, University of Virginia, Charlottesville, Virginia
| | | | - Zhiyuan Xu
- Departments of 1Neurological Surgery and
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Cerebral Arteriovenous Malformations and Epilepsy, Part 2: Predictors of Seizure Outcomes Following Radiosurgery. World Neurosurg 2015; 84:653-62. [DOI: 10.1016/j.wneu.2015.04.064] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/23/2022]
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30
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Liu S, Chen HX, Mao Q, You C, Xu JG. Factors associated with seizure occurrence and long-term seizure control in pediatric brain arteriovenous malformation: a retrospective analysis of 89 patients. BMC Neurol 2015; 15:155. [PMID: 26311038 PMCID: PMC4550043 DOI: 10.1186/s12883-015-0402-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 08/07/2015] [Indexed: 02/05/2023] Open
Abstract
Background Few studies have examined seizures in pediatric brain arteriovenous malformation. In our study, risk factors associated with seizure occurrence and long-term seizure control outcomes after different treatments in pediatric arteriovenous malformation patients were investigated. Methods A retrospective analysis was conducted with clinical data from a cohort of 89 pediatric brain arteriovenous malformation patients acquired between 2008 and 2013. Univariate and multivariate analyses were used to assess risk factors associated with seizure incidence. Patients who presented with seizure before treatment were evaluated using the Engel classification during the follow-up period. Results A higher risk of seizure occurrence was observed in large size and unruptured brain arteriovenous malformations using multivariate logistic regression analysis (p < 0.05). A total of 22 children, who presented with seizure before the interventions, were included in subsequent analysis. During a mean follow-up period of 2.3 years after the intervention, 12 (55 %) of these children were classified as Engel class I after treatment. Conclusions Seizures were the most common symptom in unruptured bAVMs. Size of the brain arteriovenous malformation is highly significant to seizure occurrence. Patients with cerebral hemorrhage are prone to having an acute seizure occurrence. The different therapies examined all improved seizure control to varying degrees. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0402-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuang Liu
- Department of Neurosurgery, West China hospital of Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
| | - Hong-Xu Chen
- Department of Neurosurgery, West China hospital of Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
| | - Qing Mao
- Department of Neurosurgery, West China hospital of Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
| | - Chao You
- Department of Neurosurgery, West China hospital of Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
| | - Jian-Guo Xu
- Department of Neurosurgery, West China hospital of Sichuan University, 37 Guoxue Street, Chengdu, 610041, People's Republic of China.
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von der Brelie C, Simon M, Esche J, Schramm J, Boström A. Seizure Outcomes in Patients With Surgically Treated Cerebral Arteriovenous Malformations. Neurosurgery 2015. [DOI: 10.1227/neu.0000000000000919] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Epilepsy is the second most common symptom in cerebral arteriovenous malformation (AVM) patients. The consecutive reduction of life quality is a clinically underrated problem because treatment usually focuses on the prevention of intracerebral hemorrhage.
OBJECTIVE:
To evaluate postoperative seizure outcome with the aim of more accurate counseling for postoperative seizure outcome.
METHODS:
From 1985 to 2012, 293 patients with an AVM were surgically treated by J.S. One hundred twenty-six patients with preoperative seizures or epilepsy could be identified; 103 of 126 had a follow-up of at least 12 months and were included in the analysis. The different epilepsy subtypes were categorized (sporadic seizures, chronic epilepsy, drug-resistant epilepsy [DRE]). Preoperative workup and surgical technique were evaluated. Seizure outcome was analyzed by using International League Against Epilepsy classification.
RESULTS:
Sporadic seizures were identified in 41% of patients (chronic epilepsy and DRE were identified in 36% and 23%, respectively). Detailed preoperative epileptological workup was done in 13%. Seizure freedom was achieved in 77% (79% at 5 years, 84% at 10 years). Outcome was significantly poorer in DRE cases. More extensive resection was performed in 11 cases with longstanding symptoms (>24 months) and resulted in better seizure outcome as well as the short duration of preoperative seizure history.
CONCLUSION:
Patients presenting with AVM-associated epilepsy have a favorable seizure outcome after surgical treatment. Long-standing epilepsy and the progress into DRE markedly deteriorate the chances to obtain seizure freedom and should be considered an early factor in establishing the indication for AVM removal.
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Affiliation(s)
| | - Matthias Simon
- Department of Neurosurgery, University of Bonn Medical Centre, Bonn, Germany
| | - Jonas Esche
- Department of Neurosurgery, University of Bonn Medical Centre, Bonn, Germany
| | - Johannes Schramm
- Department of Neurosurgery, University of Bonn Medical Centre, Bonn, Germany
| | - Azize Boström
- Department of Neurosurgery, University of Bonn Medical Centre, Bonn, Germany
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Przybylowski CJ, Ding D, Starke RM, Yen CP, Quigg M, Dodson B, Ball BZ, Sheehan JP. Seizure and anticonvulsant outcomes following stereotactic radiosurgery for intracranial arteriovenous malformations. J Neurosurg 2015; 122:1299-305. [PMID: 25614948 DOI: 10.3171/2014.11.jns141388] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Epilepsy associated with arteriovenous malformations (AVMs) has an unclear course after stereotactic radiosurgery (SRS). Neither the risks of persistent seizures nor the requirement for postoperative antiepileptic drugs (AEDs) are well defined. METHODS The authors performed a retrospective review of all patients with AVMs who underwent SRS at the University of Virginia Health System from 1989 to 2012. Seizure status was categorized according to a modified Engel classification. The effects of demographic, AVM-related, and SRS treatment factors on seizure outcomes were evaluated with logistic regression analysis. Changes in AED status were evaluated using McNemar's test. RESULTS Of the AVM patients with pre- or post-SRS seizures, 73 with pre-SRS epilepsy had evaluable data for subsequent analysis. The median patient age was 37 years (range 5-69 years), and the median follow-up period was 65.6 months (range 12-221 months). Sixty-five patients (89%) achieved seizure remission (Engel Class IA or IB outcome). Patients presenting with simple partial or secondarily generalized seizures were more likely to achieve Engel Class I outcome (p = 0.045). Twenty-one (33%) of 63 patients tapered off of pre-SRS AEDs. The incidence of freedom from AED therapy increased significantly after SRS (p < 0.001, McNemar's test). Of the Engel Class IA patients who continued AED therapy, 54% had patent AVM nidi, whereas only 19% continued AED therapy with complete AVM obliteration (p = 0.05). CONCLUSIONS Stereotactic radiosurgery is an effective treatment for long-term AVM-related epilepsy. Seizure-free patients on continued AED therapy were more likely to have residual AVM nidi. Simple partial or secondarily generalized seizure type were associated with better seizure outcomes following SRS.
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Affiliation(s)
| | - Dale Ding
- Departments of 1Neurological Surgery
| | | | | | | | | | | | - Jason P Sheehan
- Departments of 1Neurological Surgery.,3Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia
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33
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Bowden G, Kano H, Tonetti D, Niranjan A, Flickinger J, Arai Y, Lunsford LD. Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes. J Neurosurg 2014; 121:637-44. [DOI: 10.3171/2014.5.jns132244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Sylvian fissure arteriovenous malformations (AVMs) present substantial management challenges because of the critical adjacent blood vessels and functional brain. The authors investigated the outcomes, especially hemorrhage and seizure activity, after stereotactic radiosurgery (SRS) of AVMs within or adjacent to the sylvian fissure.
Methods
This retrospective single-institution analysis examined the authors' experiences with Gamma Knife surgery for AVMs of the sylvian fissure in cases treated from 1987 through 2009. During this time, 87 patients underwent SRS for AVMs in the region of the sylvian fissure. Before undergoing SRS, 40 (46%) of these patients had experienced hemorrhage and 36 (41%) had had seizures. The median target volume of the AVM was 3.85 cm3 (range 0.1–17.7 cm3), and the median marginal dose of radiation was 20 Gy (range 13–25 Gy).
Results
Over a median follow-up period of 64 months (range 3–275 months), AVM obliteration was confirmed by MRI or angiography for 43 patients. The actuarial rates of confirmation of total obliteration were 35% at 3 years, 60% at 4 and 5 years, and 76% at 10 years. Of the 36 patients who had experienced seizures before SRS, 19 (53%) achieved outcomes of Engel class I after treatment. The rate of seizure improvement was 29% at 3 years, 36% at 5 years, 50% at 10 years, and 60% at 15 years. No seizures developed after SRS in patients who had been seizure free before treatment. The actuarial rate of AVM hemorrhage after SRS was 5% at 1, 5, and 10 years. This rate equated to an annual hemorrhage rate during the latency interval of 1%; no hemorrhages occurred after confirmed obliteration. No permanent neurological deficits developed as an adverse effect of radiation; however, delayed cyst formation occurred in 3 patients.
Conclusions
Stereotactic radiosurgery was an effective treatment for AVMs within the region of the sylvian fissure, particularly for smaller-volume AVMs. After SRS, a low rate of hemorrhage and improved seizure control were also evident.
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Affiliation(s)
- Greg Bowden
- 1Departments of Neurological Surgery and
- 3Center for Image-Guided Neurosurgery,
- 5Department of Neurological Surgery, University of Western Ontario, London, Ontario, Canada
| | - Hideyuki Kano
- 1Departments of Neurological Surgery and
- 3Center for Image-Guided Neurosurgery,
| | - Daniel Tonetti
- 4University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Ajay Niranjan
- 1Departments of Neurological Surgery and
- 3Center for Image-Guided Neurosurgery,
| | - John Flickinger
- 2Radiation Oncology, and
- 3Center for Image-Guided Neurosurgery,
| | - Yoshio Arai
- 2Radiation Oncology, and
- 3Center for Image-Guided Neurosurgery,
| | - L. Dade Lunsford
- 1Departments of Neurological Surgery and
- 3Center for Image-Guided Neurosurgery,
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Chen CJ, Chivukula S, Ding D, Starke RM, Lee CC, Yen CP, Xu Z, Sheehan JP. Seizure outcomes following radiosurgery for cerebral arteriovenous malformations. Neurosurg Focus 2014; 37:E17. [DOI: 10.3171/2014.6.focus1454] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Seizures are a common presentation of cerebral arteriovenous malformations (AVMs). The authors evaluated the efficacy of stereotactic radiosurgery (SRS) for the management of seizures associated with AVMs and identified factors influencing seizure outcomes following SRS for AVMs.
Methods
A systematic literature review was performed using PubMed. Studies selected for review were published in English, included at least 5 patients with both cerebral AVMs and presenting seizures treated with SRS, and provided post-SRS outcome data regarding obliteration of AVMs and/or seizures. Demographic, radiosurgical, radiological, and seizure outcome data were extracted and analyzed. All seizure outcomes were categorized as follows: 1) seizure free, 2) seizure improvement, 3) seizure unchanged, and 4) seizure worsened. Systematic statistical analysis was conducted to assess the effect of post-SRS AVM obliteration on seizure outcome.
Results
Nineteen case series with a total of 3971 AVM patients were included for analysis. Of these, 28% of patients presented with seizures, and data for 997 patients with available seizure outcome data who met the inclusion criteria were evaluated. Of these, 437 (43.8%) patients achieved seizure-free status after SRS, and 530 (68.7%) of 771 patients with available data achieved seizure control (seizure freedom or seizure improvement) following SRS. Factors associated with improved seizure outcomes following SRS for AVMs were analyzed in 9 studies. Seizure-free status was achieved in 82% and 41.0% of patients with complete and incomplete AVM obliteration, respectively. Complete AVM obliteration offered superior seizure-free rates compared with incomplete AVM obliteration (OR 6.13; 95% CI 2.16–17.44; p = 0.0007).
Conclusions
Stereotactic radiosurgery offers favorable seizure outcomes for AVM patients presenting with seizures. Improved seizure control is significantly more likely with complete AVM obliteration.
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Affiliation(s)
- Ching-Jen Chen
- 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Srinivas Chivukula
- 2 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Dale Ding
- 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert M. Starke
- 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Cheng-Chia Lee
- 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
- 3 Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Po Yen
- 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Zhiyuan Xu
- 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Jason P. Sheehan
- 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
- 4 Department of Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia
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Steiger HJ, Etminan N, Hänggi D. Epilepsy and headache after resection of cerebral arteriovenous malformations. ACTA NEUROCHIRURGICA. SUPPLEMENT 2014; 119:113-5. [PMID: 24728643 DOI: 10.1007/978-3-319-02411-0_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The therapeutic benefits of microsurgery for cerebral arteriovenous malformations (AVM) with regard to headache and epilepsy are not well known. The objective of the present review is to discuss the available evidence and our own experience, which showed that two-thirds of the patients with preoperative epilepsy experienced long-term improvement, one-sixth no significant change, and an equal number worsening. New seizures occurred postoperatively in 18 % of the patients presenting with hemorrhage. Regarding headache, 40 % of patients with preoperative chronic headache reported improvement and 50 % described no change, whereas 10 % suffered from deterioration. With regard to epilepsy, the available literature suggests, that an epileptological approach with preoperative identification of the seizure focus and corresponding resection might improve the results. With regard to headache outcome, almost no information is available in the literature, suggesting that these complaints of the patients have so far not received the necessary attention. In conclusion, the long-term treatment results regarding chronic epilepsy and chronic headache need further study and optimization.
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Affiliation(s)
- Hans-Jakob Steiger
- Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 13.71, Düsseldorf, D-40225, Germany,
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Baranoski JF, Grant RA, Hirsch LJ, Visintainer P, Gerrard JL, Günel M, Matouk CC, Spencer DD, Bulsara KR. Seizure control for intracranial arteriovenous malformations is directly related to treatment modality: a meta-analysis. J Neurointerv Surg 2013; 6:684-90. [DOI: 10.1136/neurintsurg-2013-010945] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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37
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Wang JY, Yang W, Ye X, Rigamonti D, Coon AL, Tamargo RJ, Huang J. Impact on Seizure Control of Surgical Resection or Radiosurgery for Cerebral Arteriovenous Malformations. Neurosurgery 2013; 73:648-55; discussion 655-6. [DOI: 10.1227/neu.0000000000000071] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Seizures are a common presenting symptom of arteriovenous malformations (AVMs). However, the impact of treatment modality on seizure control remains unclear.
OBJECTIVE:
To compare seizure control after surgical resection or radiosurgery for AVMs.
METHODS:
We analyzed retrospectively collected information for 378 patients with cerebral AVMs treated at our institution from 1990 to 2010. The application of strict inclusion criteria resulted in a study population of 164 patients.
RESULTS:
In our cohort, 31 patients (20.7%) had Spetzler-Martin grade I AVMs, 51 (34.0%) grade II, 47 (31.3%) grade III, 20 (13.3%) grade IV, and 1 (0.7%) grade V. Of the 49 patients (30%) presenting with seizures, 60.4% experienced seizure persistence after treatment. For these patients, radiosurgery was associated with seizure recurrence (odds ratio: 4.32, 95% confidence interval: 1.24-15.02, P = .021). AVM obliteration was predictive of seizure freedom at last follow-up (P = .002). In contrast, for patients presenting without seizures, 18.4% experienced de novo seizures after treatment, for which surgical resection was identified as an independent risk factor (hazard ratio: 8.65, 95% confidence interval: 3.05-24.5, P < .001).
CONCLUSION:
Although our data suggest that achieving seizure freedom should not be the primary goal of AVM treatment, surgical resection may result in improved seizure control compared with radiosurgery for patients who present with seizures. Conversely, in patients without presenting seizures, surgical resection increases the risk of new-onset seizures compared with radiosurgery, but primarily within the early posttreatment period. Surgical resection and radiosurgery result in divergent seizure control rates depending on seizure presentation.
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Affiliation(s)
- Joanna Y. Wang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniele Rigamonti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander L. Coon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rafael J. Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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