Skip to main content

Advertisement

SpringerLink
Log in

Exclusion treatment of ruptured and unruptured low-grade brain arteriovenous malformations: a systematic review

  • Review
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

To assess the obliteration rate, functional outcome, hemorrhagic complication, and mortality rates of exclusion treatment of low-grade brain arteriovenous malformations (BAVMs) (Spetzler and Martin grades (SMGs) 1 and 2), either ruptured or unruptured.

Methods

Electronic databases—Ovid MEDLINE and PubMed—were searched for studies in which there was evidence of exclusion treatment of low-grade BAVMs treated either by endovascular, surgical, radiosurgical, or multimodality treatment. The primary outcome of interest was angiographic obliteration post-treatment and at follow-up. The secondary outcomes of interest were functional outcome (mRS), mortality rate, and hemorrhagic complication. Descriptive statistics were used to calculate rates and means.

Results

Eleven studies involving 1809 patients with low-grade BAVMs were included. Among these, 1790 patients treated by either endovascular, surgical, radiosurgical, or multimodality treatment were included in this analysis. Seventy-two percent of BAVMs were Spetzler-Martin grade II. The overall (i.e., including all exclusion treatment modalities) complete obliteration rate ranged from 36.5 to 100%. The overall symptomatic hemorrhagic complication rate ranged from 0 to 7.3%; procedure-related mortality ranged from 0 to 4.7%.

Conclusion

Our systematic review of the literature reveals a high overall obliteration rate for low-grade BAVMs, either ruptured or unruptured, with low mortality rate and an acceptable post-treatment hemorrhagic complication rate. These results suggest that exclusion treatment of low-grade BAVMs may be safe and effective, regardless of the treatment modality chosen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BAVMs:

Brain arteriovenous malformations

SMG:

Spetzler-Martin grade

mRS:

Modified Rankin scale

EVT:

Endovascular treatment

SRS:

Stereotactic radiosurgery

References

  1. Conger A, Kulwin C, Lawton MT, Cohen-Gadol AA (2015) Diagnosis and evaluation of intracranial arteriovenous malformations. Surg Neurol Int 6.https://doi.org/10.4103/2152-7806.156866

  2. Nataraj A, Mohamed MB, Gholkar A et al (2014) Multimodality treatment of cerebral arteriovenous malformations. World Neurosurg 82:149–159. https://doi.org/10.1016/j.wneu.2013.02.064

    Article  PubMed  Google Scholar 

  3. Deruty R, Pelissou-Guyotat I, Morel C, et al (1998) Reflections on the management of cerebral arteriovenous malformations. Surg Neurol 50:245–255; discussion 255–256. https://doi.org/10.1016/s0090-3019(98)00082-2

  4. Hillman J (2001) Population-based analysis of arteriovenous malformation treatment. J Neurosurg 95:633–637. https://doi.org/10.3171/jns.2001.95.4.0633

    Article  CAS  PubMed  Google Scholar 

  5. Brown RD, Wiebers DO, Forbes GS (1990) Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions. J Neurosurg 73:859–863. https://doi.org/10.3171/jns.1990.73.6.0859

    Article  PubMed  Google Scholar 

  6. Brown RD, Wiebers DO, Forbes G et al (1988) The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 68:352–357. https://doi.org/10.3171/jns.1988.68.3.0352

    Article  PubMed  Google Scholar 

  7. Hamilton MG, Spetzler RF (1994) The prospective application of a grading system for arteriovenous malformations. Neurosurgery 34:2–6 (discussion 6-7)

    Article  CAS  Google Scholar 

  8. Heros RC, Korosue K, Diebold PM (1990) Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:570–577; discussion 577–578. https://doi.org/10.1097/00006123-199004000-00003

  9. Morgan MK, Johnston IH, Hallinan JM, Weber NC (1993) Complications of surgery for arteriovenous malformations of the brain. J Neurosurg 78:176–182. https://doi.org/10.3171/jns.1993.78.2.0176

    Article  CAS  PubMed  Google Scholar 

  10. Mohr JP, Parides MK, Stapf C et al (2014) Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet Lond Engl 383:614–621. https://doi.org/10.1016/S0140-6736(13)62302-8

    Article  CAS  Google Scholar 

  11. Mohr JP, Overbey JR, von Kummer R et al (2017) Functional impairments for outcomes in a randomized trial of unruptured brain AVMs. Neurology 89:1499–1506. https://doi.org/10.1212/WNL.0000000000004532

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Hamilton MGSR (1994) The prospective application of a grading system for arteriovenous malformations. Neurosurgery 34:2–7

    Article  CAS  Google Scholar 

  13. Liberati A, Altman DG, Tetzlaff J, et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339.https://doi.org/10.1136/bmj.b2700

  14. Burns PB, Rohrich RJ, Chung KC (2011) The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 128:305–310. https://doi.org/10.1097/PRS.0b013e318219c171

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Institute of Medicine (US) Committee on Standards for Systematic Reviews of Comparative Effectiveness Research (2011) Finding what works in health care: standards for systematic reviews. National Academies Press (US), Washington (DC)

  16. Hung AL, Yang W, Westbroek EM et al (2017) Differences in functional outcome across subtypes with Spetzler-Martin grade II arteriovenous malformations. Neurosurgery 81:441–449. https://doi.org/10.1093/neuros/nyw140

    Article  PubMed  Google Scholar 

  17. Baharvahdat H, Blanc R, Fahed R et al (2019) Endovascular treatment for low-grade (Spetzler-Martin I-II) brain arteriovenous malformations. AJNR Am J Neuroradiol 40:668–672. https://doi.org/10.3174/ajnr.A5988

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Iosif C, de Lucena AF, Abreu-Mattos LG et al (2019) Curative endovascular treatment for low-grade Spetzler-Martin brain arteriovenous malformations: a single-center prospective study. J NeuroInterventional Surg 11:699–705. https://doi.org/10.1136/neurintsurg-2018-014390

    Article  Google Scholar 

  19. Potts MB, Lau D, Abla AA et al (2015) Current surgical results with low-grade brain arteriovenous malformations. J Neurosurg 122:912–920. https://doi.org/10.3171/2014.12.JNS14938

    Article  PubMed  PubMed Central  Google Scholar 

  20. Morgan MK, Rochford AM, Tsahtsarlis A et al (2004) Surgical risks associated with the management of grade I and II brain arteriovenous malformations. Neurosurgery 54:832–837; discussion 837–839. https://doi.org/10.1227/01.neu.0000114264.78966.be

  21. Aboukaïs R, Quidet M, Baroncini M et al (2017) Grade 1 Spetzler and Martin cerebral ruptured arteriovenous malformations treated by microsurgery: Poor functional outcome is related to injury from haemorrhage. Neurochirurgie 63:69–73. https://doi.org/10.1016/j.neuchi.2016.10.010

    Article  PubMed  Google Scholar 

  22. Moon K, Levitt MR, Almefty RO et al (2015) Safety and efficacy of surgical resection of unruptured low-grade arteriovenous malformations from the modern decade. Neurosurgery 77:948–952; discussion 952–953. https://doi.org/10.1227/NEU.0000000000000968

  23. Sisti MB, Kader A, Stein BM (1993) Microsurgery for 67 intracranial arteriovenous malformations less than 3 cm in diameter. J Neurosurg 79:653–660. https://doi.org/10.3171/jns.1993.79.5.0653

    Article  CAS  PubMed  Google Scholar 

  24. Kano H, Lunsford LD, Flickinger JC et al (2012) Stereotactic radiosurgery for arteriovenous malformations, part 1: management of Spetzler-Martin grade I and II arteriovenous malformations. J Neurosurg 116:11–20. https://doi.org/10.3171/2011.9.JNS101740

    Article  PubMed  Google Scholar 

  25. Ding D, Starke RM, Kano H et al (2017) Stereotactic radiosurgery for ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-eligible Spetzler-Martin grade I and II arteriovenous malformations: a multicenter study. World Neurosurg 102:507–517. https://doi.org/10.1016/j.wneu.2017.03.061

    Article  PubMed  Google Scholar 

  26. Wang A, Mandigo GK, Feldstein NA et al (2020) Curative treatment for low-grade arteriovenous malformations. J Neurointerventional Surg 12:48–54. https://doi.org/10.1136/neurintsurg-2019-015115

    Article  CAS  Google Scholar 

  27. Teo MK, Young AMH, St George EJ (2016) Comparative surgical outcome associated with the management of brain arteriovenous malformation in a regional neurosurgical centre. Br J Neurosurg 30:623–630. https://doi.org/10.1080/02688697.2016.1199776

    Article  PubMed  Google Scholar 

  28. van Beijnum J, van der Worp HB, Buis DR et al (2011) Treatment of brain arteriovenous malformations: a systematic review and meta-analysis. JAMA 306:2011–2019. https://doi.org/10.1001/jama.2011.1632

    Article  PubMed  Google Scholar 

  29. Magro E, Gentric J-C, Batista AL et al (2018) The Treatment of Brain AVMs Study (TOBAS): an all-inclusive framework to integrate clinical care and research. J Neurosurg 128:1823–1829. https://doi.org/10.3171/2017.2.JNS162751

    Article  PubMed  Google Scholar 

  30. Stefani MA, Sgarabotto Ribeiro D, Mohr JP (2019) Grades of brain arteriovenous malformations and risk of hemorrhage and death. Ann Clin Transl Neurol 6:508–514. https://doi.org/10.1002/acn3.723

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Interventional Neuroradiology, GRC BioFast, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 75013, Paris, France

    Maichael Talaat & Frédéric Clarençon

  2. Department of Radiodiagnosis, Faculty of Medicine, Zagazig University E44519, Zagazig, Egypt

    Maichael Talaat, Awad Bessar & Mohammed Taema

  3. Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 47-83 Boulevard de l’Hôpital 75013, Paris, France

    Kévin Premat, Stéphanie Lenck, Eimad Shotar, Nader Sourour & Frédéric Clarençon

  4. Department of Neurosurgery, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 75013, Paris, France

    Anne-Laure Boch

  5. Department of Radiodiagnosis, Faculty of Medicine, Cairo University, Cairo, C12613, Egypt

    Farouk Hassan

  6. Department of Neurology, Faculty of Medicine, Zagazig University, Zagazig, E44519, Egypt

    Tamer S. Elserafy

  7. Department of Anesthesiology and Critical Care, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 75013, Paris, France

    Vincent Degos

Authors
  1. Maichael Talaat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kévin Premat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stéphanie Lenck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eimad Shotar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne-Laure Boch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Awad Bessar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mohammed Taema
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Farouk Hassan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tamer S. Elserafy
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Vincent Degos
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nader Sourour
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Frédéric Clarençon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frédéric Clarençon.

Ethics declarations

Conflict of interest

Dr. Sourour reports a conflict of interest with Medtronic, Balt Extrusion, Microvention (consultant), and Stock/Stock Options: Medina. Prof. Clarençon reports a conflict of interest with Medtronic, Guerbet, Balt Extrusion (payment for readings), and Codman Neurovascular (core lab). The other authors report no conflicts of interest.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

Not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Talaat, M., Premat, K., Lenck, S. et al. Exclusion treatment of ruptured and unruptured low-grade brain arteriovenous malformations: a systematic review. Neuroradiology 64, 5–14 (2022). https://doi.org/10.1007/s00234-021-02714-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-021-02714-x

Keywords

Search

Navigation