Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience
Objective The aims of this study are to clarify the long-term outcomes of brainstem arteriovenous malformations (AVMs) after different management modalities.Methods The authors retrospectively reviewed 61 brainstem AVMs in their institution between 2011 and 2017. The rupture risk was represented by...
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BMJ Publishing Group
2021-03-01
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Series: | Stroke and Vascular Neurology |
Online Access: | https://svn.bmj.com/content/6/1/65.full |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hao Wang Shuo Wang Li Ma Yu Chen Xun Ye Xiaolin Chen Yuanli Zhao Hengwei Jin Xiangyu Meng Youxiang Li Ruinan Li Debin Yan Dezhi Gao Shibin Sun Ali Liu |
spellingShingle |
Hao Wang Shuo Wang Li Ma Yu Chen Xun Ye Xiaolin Chen Yuanli Zhao Hengwei Jin Xiangyu Meng Youxiang Li Ruinan Li Debin Yan Dezhi Gao Shibin Sun Ali Liu Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience Stroke and Vascular Neurology |
author_facet |
Hao Wang Shuo Wang Li Ma Yu Chen Xun Ye Xiaolin Chen Yuanli Zhao Hengwei Jin Xiangyu Meng Youxiang Li Ruinan Li Debin Yan Dezhi Gao Shibin Sun Ali Liu |
author_sort |
Hao Wang |
title |
Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience |
title_short |
Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience |
title_full |
Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience |
title_fullStr |
Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience |
title_full_unstemmed |
Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience |
title_sort |
long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience |
publisher |
BMJ Publishing Group |
series |
Stroke and Vascular Neurology |
issn |
2059-8696 |
publishDate |
2021-03-01 |
description |
Objective The aims of this study are to clarify the long-term outcomes of brainstem arteriovenous malformations (AVMs) after different management modalities.Methods The authors retrospectively reviewed 61 brainstem AVMs in their institution between 2011 and 2017. The rupture risk was represented by annualised haemorrhagic rate. Patients were divided into five groups: conservation, microsurgery, embolisation, stereotactic radiosurgery (SRS) and embolisation+SRS. Neurofunctional outcomes were evaluated by the modified Rankin Scale (mRS). Subgroup analysis was conducted between different management modalities to compare the long-term outcomes in rupture or unruptured cohorts.Results All of 61 brainstem AVMs (12 unruptured and 49 ruptured) were followed up for an average of 4.5 years. The natural annualised rupture risk was 7.3%, and the natural annualised reruptured risk in the ruptured cohort was 8.9%. 13 cases were conservative managed and 48 cases underwent intervention (including 6 microsurgery, 12 embolisation, 21 SRS and 9 embolisation+SRS). In the selection of interventional indication, diffuse nidus were often suggested conservative management (p=0.004) and nidus involving the midbrain were more likely to be recommended for intervention (p=0.034). The risk of subsequent haemorrhage was significantly increased in partial occlusion compared with complete occlusion and conservative management (p<0.001, p=0.036, respectively). In the subgroup analysis, the follow-up mRS scores of different management modalities were similar whether in the rupture cohort (p=0.064) or the unruptured cohort (p=0.391), as well as the haemorrhage-free survival (p=0.145). In the adjusted Bonferroni correction analysis of the ruptured cohort, microsurgery and SRS could significantly improve the obliteration rate compared with conservation (p<0.001, p=0.001, respectively) and SRS may have positive effect on avoiding new-onset neurofunctional deficit compared with microsurgery and embolisation (p=0.003, p=0.003, respectively).Conclusions Intervention has similar neurofunctional outcomes as conservation in these brainstem AVM cohorts. If intervention is adopted, partial obliteration should be avoided because of the high subsequent rupture risk.Trial registration number NCT04136860. |
url |
https://svn.bmj.com/content/6/1/65.full |
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doaj-829d84223b364666aec10cd332f66e5d2021-09-30T17:43:52ZengBMJ Publishing GroupStroke and Vascular Neurology2059-86962021-03-016110.1136/svn-2020-000407Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experienceHao Wang0Shuo Wang1Li Ma2Yu Chen3Xun Ye4Xiaolin Chen5Yuanli Zhao6Hengwei Jin7Xiangyu Meng8Youxiang Li9Ruinan Li10Debin Yan11Dezhi Gao12Shibin Sun13Ali Liu14Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, School of Medicine, Tongji University, Shanghai 200092, China1 Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China1 Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, ChinaState Key Lab of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China1 Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, ChinaNeurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaNeurosurgery Department, Peking University International Hospital, Beijing, ChinaDepartment of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China3 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China2 Beijing Neurosurgical Institute, Capital Medical University, Beijing, China1 Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China1 Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China6 Department of Gamma-Knife Center, Beijing Tiantan Hospital, Beijing, China6 Department of Gamma-Knife Center, Beijing Tiantan Hospital, Beijing, China6 Department of Gamma-Knife Center, Beijing Tiantan Hospital, Beijing, ChinaObjective The aims of this study are to clarify the long-term outcomes of brainstem arteriovenous malformations (AVMs) after different management modalities.Methods The authors retrospectively reviewed 61 brainstem AVMs in their institution between 2011 and 2017. The rupture risk was represented by annualised haemorrhagic rate. Patients were divided into five groups: conservation, microsurgery, embolisation, stereotactic radiosurgery (SRS) and embolisation+SRS. Neurofunctional outcomes were evaluated by the modified Rankin Scale (mRS). Subgroup analysis was conducted between different management modalities to compare the long-term outcomes in rupture or unruptured cohorts.Results All of 61 brainstem AVMs (12 unruptured and 49 ruptured) were followed up for an average of 4.5 years. The natural annualised rupture risk was 7.3%, and the natural annualised reruptured risk in the ruptured cohort was 8.9%. 13 cases were conservative managed and 48 cases underwent intervention (including 6 microsurgery, 12 embolisation, 21 SRS and 9 embolisation+SRS). In the selection of interventional indication, diffuse nidus were often suggested conservative management (p=0.004) and nidus involving the midbrain were more likely to be recommended for intervention (p=0.034). The risk of subsequent haemorrhage was significantly increased in partial occlusion compared with complete occlusion and conservative management (p<0.001, p=0.036, respectively). In the subgroup analysis, the follow-up mRS scores of different management modalities were similar whether in the rupture cohort (p=0.064) or the unruptured cohort (p=0.391), as well as the haemorrhage-free survival (p=0.145). In the adjusted Bonferroni correction analysis of the ruptured cohort, microsurgery and SRS could significantly improve the obliteration rate compared with conservation (p<0.001, p=0.001, respectively) and SRS may have positive effect on avoiding new-onset neurofunctional deficit compared with microsurgery and embolisation (p=0.003, p=0.003, respectively).Conclusions Intervention has similar neurofunctional outcomes as conservation in these brainstem AVM cohorts. If intervention is adopted, partial obliteration should be avoided because of the high subsequent rupture risk.Trial registration number NCT04136860.https://svn.bmj.com/content/6/1/65.full |