Predicament and Challenges in the Treatment of Intracranial Arterio-Venous Malformations

Bing Leng


Arterio-venous malformation (AVM) is the most common clinical disease caused by intracranial vascular dysplasia. AVM has particular importance in the clinical setting and is difficult to treat because of its high disability and case fatality rate, as well as the uncertainty of its natural course and complex blood flow structure. The treatments for arterio-venous malformations mainly include conservative treatment, surgical resection, endovascular interventional treatment and stereotactic radiotherapy. It is difficult to discern the so-called arterio-venous malformation treatment norms within the clinical setting, as there are many different treatment combinations, different arterio-venous malformation classifications, different clinical manifestations and different high risk factors. Therefore, we are faced with a challenge regarding the treatment of intracranial arterio-venous malformations in clinical practice.

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van Beijnum J, van der Worp HB, Buis DR, Al-Shahi Salman R, Kappelle LJ, Rinkel GJ, van der Sprenkel JW, Vandertop WP, Algra A, Klijn CJ. Treatment of brain arteriovenous malformations: a systematic review and meta-analysis. JAMA, 2011, 306(18):2011-9.

Gross BA, Du R. Natural history of cerebral arteriovenous malformations: a meta-analysis. J Neurosurg, 2013, 118(2):437-43.

Mohr JP, Parides MK, Stapf C, Moquete E, Moy CS, Overbey JR, Al-Shahi Salman R, Vicaut E, Young WL, Houdart E, Cordonnier C, Stefani MA, Hartmann A, von Kummer R, Biondi A, Berkefeld J, Klijn CJ, Harkness K, Libman R, Barreau X, Moskowitz AJ; international ARUBA investigators. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicenter, non-blinded, randomized trial. Lancet, 2014, 383(9917):614-21

Bai jie, Dou chang-wu, WANG Ya-jie, Liu li, Zhao ji-zong,Wang shuo, Zhao yuan-li. Correlation s of angioarchitectural factors with cerebral arteriovenous malformation hemorrhage. Natl Med J China, 2012.92(3 1):2202-04. [白杰,窦长武,王雅杰,等。脑动静脉畸形血管构筑特征与出血的关系。中华医学杂志,2012,92(31):2202-04.]

Josephson CB, Bhattacharya JJ, Counsell CE, Papanastassiou V, Ritchie V, Roberts R, Sellar R, Warlow CP, Al-Shahi Salman R; Scottish Audit of Intracranial Vascular Malformations (SAIVMs) steering committee and collaborators. Seizure risk with AVM treatment or conservative management: prospective, population-based study. Neurology, 2012, 79(6):500-7.

Elhammady MS1, Heros RC. Management of incidental cerebral AVMs in the post-ARUBA era. J Neurosurg, 2014, 121(5):1011-4.

Cockroft KM, Jayaraman MV, Amin-Hanjani S, Derdeyn CP, McDougall CG, Wilson JA. A perfect storm: how a randomized trial of unruptured brain arteriovenous malformations' (ARUBA's) trial design challenges notions of external validity. Stroke, 2012, 43(7):1979-81.

Day AL, Dannenbaum M, Jung S. A randomized trial of unruptured brain arteriovenous malformations trial: an editorial review. Stroke, 2014, 45(10):3147-8.

Nerva JD, Mantovani A, Barber J, Kim LJ, Rockhill JK, Hallam DK, Ghodke BV, Sekhar LN. Treatment outcomes of unruptured arteriovenous malformations with a subgroup analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-eligible patients. Neurosurgery, 2015, 76(5):563-70.

Al-Shahi R, Bhattacharya JJ, Currie DG, Papanastassiou V, Ritchie V, Roberts RC, Sellar RJ, Warlow CP; Scottish Intracranial Vascular Malformation Study Collaborators. Scottish Intracranial Vascular Malformation Study (SIVMS): evaluation of methods, ICD-10 coding, and potential

sources of bias in a prospective, population-based cohort. Stroke, 2003, 34(5):1156-62.

Korja M1, Bervini D, Assaad N, Morgan MK. Role of surgery in the management of brain arteriovenous malformations: prospective cohort study. Stroke, 2014, 45(12):3549-55.

Zhao J, Yu T, Wang S, Zhao Y, Yang WY. Surgical treatment of giant intracranial arteriovenous malformations. Neurosurgery, 2010, 67(5):1359-70.

Bervini D, Morgan MK, Ritson EA, Heller G. Surgery for unruptured arteriovenous malformations of the brain is better than conservative management for selected cases: a prospective cohort study. J Neurosurg, 2014, 121(4):878-90.

Hyun SJ, Kong DS, Lee JI, Kim JS, Hong SC. Cerebral arteriovenous malformations and seizures: differential impact on the time to seizure-free state according to the treatment modalities. Acta Neurochir (Wien), 2012, 154(6):1003-10.

von der Brelie C, Simon M, Esche J, Schramm J, Boström A. Seizure Outcomes in Patients With Surgically Treated Cerebral Arteriovenous Malformations. Neurosurgery, 2015, 77(5):762-8.

Liu XJ, Wang S, Zhao YL, Teo M, Guo P, Zhang D, Wang R, Cao Y, Ye X, Kang S, Zhao JZ. Risk of cerebral arteriovenous malformation rupture during pregnancy and puerperium. Neurology, 2014, 82(20):1798-803.

Chen W, Choi EJ, McDougall CM, Su H. Brain arteriovenous malformation modeling, pathogenesis, and novel therapeutic targets. Transl Stroke Res, 2014, 5(3):316-29.

Ding D, Starke RM, Liu KC, Crowley RW. Cortical plasticity in patients with cerebral arteriovenous malformations. J Clin Neurosci, 2015, 22(12):1857-61.

Bose R, Agrawal D, Singh M, Kale SS, Gopishankar N, Bisht RK, Sharma BS. Draining vein shielding in intracranial arteriovenous malformations during gamma-knife: a new way of preventing post gamma-knife edema and hemorrhage. Neurosurgery, 2015, 76(5):623-31.

Yen CP, Sheehan JP, Schwyzer L, Schlesinger D. Hemorrhage risk of cerebral arteriovenous malformations before and during the latency period after GAMMA knife radiosurgery. Stroke, 2011, 42(6):1691-6.

Parkhutik V, Lago A, Tembl JI, Vázquez JF, Aparici F, Mainar E, Vázquez V. Postradiosurgery hemorrhage rates of arteriovenous malformations of the brain: influencing factors and evolution with time. Stroke, 2012, 43(5):1247-52.

Spiotta AM, James RF, Lowe SR, Vargas J, Turk AS, Chaudry MI, Bhalla T, Janjua RM, Delaney JJ, Quintero-Wolfe S, Turner RD. Balloon-augmented Onyx embolization of cerebral arteriovenous malformations using a dual-lumen balloon: a multicenter experience. J Neurointerv Surg, 2015, 7(10):721-7.

Choudhri O, Ivan ME, Lawton MT. Transvenous Approach to Intracranial Arteriovenous Malformations: Challenging the Axioms of Arteriovenous Malformation Therapy? Neurosurgery, 2015, 77(4):644-51.

Ansari SA, Schnell S, Carroll T, Vakil P, Hurley MC, Wu C, Carr J, Bendok BR, Batjer H, Markl M. Intracranial 4D flow MRI: toward individualized assessment of arteriovenous malformation hemodynamics and treatment-induced changes. AJNR Am J Neuroradiol, 2013, 34(10):1922-8.

Wang Xin, Wang Enmin, Mei Guanghai, Liu Xiaoxia, Zhu Huaguang, Pan li,Dai Jiazhong, Wang Yang. Cyberknife radiosurgery for cerebral arteriovenous malformations: outlining of the radiosurgical target and obliteration. Natl Med J China,2014,94(3 7):2902-06. [王鑫,王恩敏,梅广海,刘晓霞,诸华光,潘力,戴嘉中,汪洋。射波刀治疗脑动静脉畸形的靶区勾画和疗效分析。中华医学杂志, 2014,94(3 7):2902-06.]



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