Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Clinical and anatomic description of patients with arteriovenous malformation treated with endovascular therapy in a Mexican population

  • Mallyolo Eliezer Pelayo-Salazar (Neurological Endovascular Therapy Department, National Neurology and Neurosurgery Institute "Dr. Manuel Velasco Suarez") ;
  • Hector Alfredo Montenegro-Rosales (Neurological Endovascular Therapy Department, National Neurology and Neurosurgery Institute "Dr. Manuel Velasco Suarez") ;
  • Jorge Luis Balderrama-Banares (Neurological Endovascular Therapy Department, National Neurology and Neurosurgery Institute "Dr. Manuel Velasco Suarez") ;
  • Pablo Martinez-Arellano (Neurological Endovascular Therapy Department, National Neurology and Neurosurgery Institute "Dr. Manuel Velasco Suarez") ;
  • Omar Andres Campos-Flota (Department of Geriatrics, North Central Hospital (PEMEX)) ;
  • Laura Mestre-Orozco (Department of Surgical Pathology, The American British Cowdray Medical Center) ;
  • Julio Cesar Lopez-Valdes (Department of Neurosurgery, South Central High Specialty Hospital (PEMEX))
  • Received : 2022.06.02
  • Accepted : 2022.12.08
  • Published : 2023.03.31
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Abstract

Objective: Arteriovenous malformations (AVMs) are benign congenital lesions. The estimated prevalence is 10-18 per 100,000 individuals, with an incidence rate of 1.1-1.4 per 100,000 person-year; only 12% of AVMs present symptoms during life. It is important to study different characteristics associated with AVMs because these patients require multidisciplinary treatment. Methods: A descriptive, observational, longitudinal, and retrospective study was carried out from January 15, 2016 to October 19, 2021. Convenience sampling was used on patients diagnosed with arteriovenous malformation. Sociodemographic data was obtained, such as: sex, age, site, predominant symptoms, clinical debut, type of malformation, data associated with post therapy evolution, type of embolizing agent used, associated complications, Rankin scale, and death. Results: Data from 535 procedures was collected, we calculated an incidence of 4.4 cases per million inhabitants. Ninety procedures in 56 patients that used endovascular therapy were obtained with a female-male ratio of 0.75 and an age distribution of 35±14 (SD). A 36.3±11.5 (SD) mm diameter was registered. There was a 33% success rate for endovascular surgery. Conclusions: The multidisciplinary treatment of AVMs is made up of three pillar techniques: microsurgical resection, embolization, and radio-neurosurgery. It is extremely important to make an appropriate decision, with an emphasis on achieving better functional outcomes for the patient. Although neurological endovascular therapy was initially used as an adjuvant treatment for neurosurgery and radio-neurosurgery, it has been used more and more frequently as the first line of treatment.

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References

  1. Baharvahdat H, Blanc R, Termechi R, Pistocchi S, Bartolini B, Redjemet H, et al. Hemorrhagic complications after endovascular treatment of cerebral arteriovenous malformations. AJNR Am J Neuroradiol. 2014 May;35(5):978-83. 
  2. Bonita R, Beaglehole R. Recovery of motor function after stroke. Stroke 1988 Dec;19(12):1497-500. 
  3. Chen CJ, Ding D, Derdeyn CP, Lanzino G, Friedlander RM, Southerland AM, et al. Brain arteriovenous malformations: a review of natural history, pathobiology, and interventions. Neurology. 2020 Nov;95(20):917-27. 
  4. Chen CJ, Norat P, Ding D, Mendes GAC, Tvrdik P, Park MS, et al. Transvenous embolization of brain arteriovenous malformations: a review of techniques, indications, and outcomes. Neurosurg Focus. 2018 Jul;45(1):e13. 
  5. Chen CJ, Shabo LM, Ding D, Ironside N, Kano H, Mathieu D, et al. Seizure presentation in patients with brain arteriovenous malformations treated with stereotactic radiosurgery: a multicenter study. World Neurosurg. 2019 Jun;126:e634-40. 
  6. Chen W, Choi EJ, McDougall CM, Su H. Brain arteriovenous malformation modeling, pathogenesis, and novel therapeutic targets. Transl Stroke Res. 2014 Jun;5(3):316-29. 
  7. Comision Cordinadora de Institutos Nacionales de Salud y Hospitales de Aalta Especialidad. Manual de organizacion especifico del Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez. Gobierno de Mexico, Diciembre 2016. http://www.innn.salud.gob.mx/descargas/instituto/normateca/man_org_12.pdf 
  8. Dumont TM, Kan P, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI. A proposed grading system for endovascular treatment of cerebral arteriovenous malformations: Buffalo score. Surg Neurol Int. 2015 Jan;6:3. 
  9. Garcia-Munoz L, Vargas-Herrera A, Lujan-Castilla P, Villasenor-Navarro L. Malformaciones arteriovenosas tratadas con radiocirugia: experiencia en el Hospital General de Mexico. Rev Mex Neuroci 2010;11(1):26-9. 
  10. Gonzalez-Block MA, Reyes-Morales H, Cahuana-Hurtado L, Balandran A, Mendez E. Mexico: health system review. World Health Organization. Regional Office for Europe. Health Systems in Transition 2020;22(2):222. https://apps.who.int/iris/handle/10665/334334  10665/334334
  11. Halim AX, Singh V, Johnston SC, Higashida RT, Dowd CF, Halbach VV, et al. Characteristics of brain arteriovenous malformations with coexisting aneurysms a comparison of two referral centers. Stroke. 2002 Mar;33(3):675-9. 
  12. Hernesniemi JA, Dashti R, Juvela S, Vaart K, Niemela M, Laakso A. Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients. Neurosurgery. 2008 Nov;63(5):823-9; discussion 829-31. 
  13. Hofmeister C, Stapf C, Hartmann A, Sciacca RR, Mansmann U, terBrugge K, et al. Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation. Stroke. 2000 Jun;31(6):1307-10. 
  14. Instituto Nacional de Estadistica, Geografia e Informatica. Demografia y sociedad. derechos reservados. Last visit:28 Mar, 2022. https://www.inegi.org.mx/temas/estructura/
  15. Kim H, Abla AA, Nelson J, McCulloch CE, Bervini D, Morgan MK, et al. Validation of the supplemented Spetzler-Martin grading system for brain arteriovenous malformations in a multicenter cohort of 1009 surgical patients. Neurosurgery. 2015 Jan;76(1):25-31. 
  16. Komiyama M. Pathogenesis of brain arteriovenous malformations. Neurol Med Chir (Tokyo). 2016 Jun;56(6):317-25. 
  17. Koo HW, Jo KI, Yeon JY, Kim KH, Jeon P, Kim JS, et al. Clinical features of superficially located brain arteriovenous malformations with transdural arterial communication. Cerebrovasc Dis. 2016;41(3-4):204-10. 
  18. Larios C, Mimenza-Alvarado A, Zenteno M, Murillo-Bonilla L, Sanchez-Hernandez J, Garcia-Ramos G, et al. Comportamiento de las malformaciones arteriovensosas cerebrales: estudio de una cohorte de 302 pacientes. Rev Mex Neuroci. 2010;11(5):330-7. 
  19. Lawton MT, Kim H, McCulloch CE, Mikhak B, Young WL. A supplementary grading scale for selecting patients with brain arteriovenous malformations for surgery. Neurosurgery. 2010 Apr;66(4):702-13; discussion 713. 
  20. Lopes DK, Moftakhar R, Straus D, Munich SA, Chaus F, Kaszuba MC. Arteriovenous malformation embocure score: AVMES. J Neurointerv Surg. 2016 Jul;8(7):685-91. 
  21. Lv X, Wu Z, Li Y, Yang X, Jiang C. Hemorrhage risk after partial endovascular NBCA and ONYX embolization for brain arteriovenous malformation. Neurol Res. 2012 Jul;34(6):552-6. 
  22. Mast H, Young WL, Koennecke H, Sciacca RR, Osipov A, Pile-Spellman J, et al. Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet. 1997 Oct;350(9084):1065-8. 
  23. Melo-Guzman G, Padilla-Vazquez F, Escobar-de la Garma VH, Mendizabal-Guerra R. Experiencia en el manejo de malformaciones arteriovenosas cerebrales en el Hospital Juarez de Mexico. Rev Mex Neuroci. 2017;18(2):65-75. 
  24. Mendes GAC, Kalani MYS, Iosif C, Lucena AF, Carvalho R, Saleme S, et al. Transvenous curative embolization of cerebral arteriovenous malformations: a prospective cohort study. Neurosurgery. 2018 Nov;83(5):957-64. 
  25. Morales-Valero SF, Bortolotti C, Sturiale C, Lanzino G. Are parenchymal AVMs congenital lesions? Neurosurg Focus. 2014 Sep;37(3):e2. 
  26. Pollock BE, Link MJ, Stafford SL, Garces YI, Foote RL. Stereotactic radiosurgery for arteriovenous malformations: the effect of treatment period on patient outcomes. Neurosurgery. 2016 Apr;78(4):499-508. 
  27. Pulli B, Stapleton CJ, Walcott BP, Koch MJ, Raymond SB, Leslie- Mazwi TM, et al. Comparison of predictive grading systems for procedural risk in endovascular treatment of brain arteriovenous malformations: analysis of 104 consecutive patients. J Neurosurg. 2019 Jun;133(2):342-50. 
  28. Rankin J. Cerebral vascular accidents in patients over the age 60. Scott Med J. 1957 May;2(5):200-15. 
  29. Rodriguez-Parra V, Aburto-Murrieta Y, Zenteno-Castellanos MA. Descripcion de factores clinicos y angiograficos asociados a hemorragia en malformaciones arteriovenosas cerebrales tratadas con embolizacion. Arch Neurocien (Mex), 2010;15(4):211-6. 
  30. Saatci I, Geyik S, Yavuz K, Cekirge HS. Endovascular treatment of brain arteriovenous malformations with prolonged intranidal Onyx injection technique: long-term results in 350 consecutive patients with completed endovascular treatment course. J Neurosurg. 2011 Jul;115(1):78-88. 
  31. Soderman M, Rodesch G, Lasjaunias P. Transdural blood supply to cerebral arteriovenous malformations adjacent to the dura mater. AJNR Am J Neuroradiol. 2002 Sep;23(8):1295-300. 
  32. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986 Oct;65(4):476-83. 
  33. Starke RM, Kano H, Ding D, Lee JYK, Mathieu D, Whitesell J, et al. Stereotactic radiosurgery for cerebral arteriovenous malformations: evaluation of long-term outcomes in a multicenter cohort. J Neurosurg. 2017 Jan;126(1):36-44. 
  34. STROBE. Strengthening the reporting of observational studies in epidemiology. STROBE. Last visit:31 Mar, 2022. https://www.strobe-statement.org/
  35. Sugiyama T, Grasso G, Torregrossa F, Fujimura M. Current concepts and perspectives on brain arteriovenous malformations: a review of pathogenesis and multidisciplinary treatment. World Neurosurg. 2022 Mar;159:314-26. 
  36. Thomas JM, Surendran S, Abraham M, Rajavelu A, Kartha CC. Genetic and epigenetic mechanisms in the development of arteriovenous malformations in the brain. Vol. 8, Clinical Epigenetics. Clin Epigenetics. 2016 Jul;8:78. 
  37. Unnithan A. Overview of the current concepts in the management of arteriovenous malformations of the brain. Postgrad Med J. 2020 Apr;96(1134):212-20. 
  38. Van Rooij WJ, Jacobs S, Sluzewski M, Van Der Pol B, Beute GN, Sprengers ME. Curative embolization of brain arteriovenous malformations with onyx: patient selection, embolization technique, and results. AJNR Am J Neuroradiol. 2012 Aug;33(7):1299-304. 
  39. Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988 May;19(5):604-7.