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A novel method to determine the natural course of unruptured brain arteriovenous malformations without the need for follow-up information
Natl Univ Singapore Hosp, Div Neurosurg, Dept Surg, Singapore, Singapore..
KTH, School of Engineering Sciences (SCI), Mechanics.ORCID iD: 0000-0002-2711-4687
Vet Gen Hosp, Dept Neurosurg, Taipei, Taiwan..
Furukawa Seiryo Hosp, Jiro Suzuki Mem Gamma House, Osaki, Japan..
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2018 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 129, p. 10-16Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE There is a strong clinical need to accurately determine the average annual hemorrhage risk in unruptured brain arteriovenous malformations (AVMs). This need motivated the present initiative to use data from a uniquely large patient population and design a novel methodology to achieve a risk determination with unprecedented accuracy. The authors also aimed to determine the impact of sex, pregnancy, AVM volume, and location on the risk for AVM rupture. METHODS The present study does not consider any specific management of the AVMs, but only uses the age distribution for the first hemorrhage, the shape of which becomes universal for a sufficiently large set of patients. For this purpose, the authors collected observations, including age at first hemorrhage and AVM size and location, in 3425 patients. The average annual risk for hemorrhage could then be determined from the simple relation that the number of patients with their first hemorrhage at a specific age equals the risk for hemorrhage times the number of patients at risk at that age. For a subset of the patients, the information regarding occurrence of AVM hemorrhage after treatment of the first hemorrhage was used for further analysis of the influence on risk from AVM location and pregnancy. RESULTS The age distribution for the first AVM hemorrhage was used to determine the average annual risk for hemorrhage in unruptured AVMs at adult ages (25-60 years). It was concluded to be 3.1% +/- 0.2% and unrelated to AVM volume but influenced by its location, with the highest risk for centrally located AVMs. The hemorrhage risk was found to be significantly higher for females in their fertile years. CONCLUSIONS The present methodology allowed the authors to determine the average annual risk for the first AVM hemorrhage at 3.1% +/- 0.2% without the need for individual patient follow-up. This methodology has potential also for other similar types of investigations. The conclusion that centrally located AVMs carry a higher risk was confirmed by follow-up information. Follow-up information was also used to conclude that pregnancy causes a substantially greater AVM hemorrhage risk. The age distribution for AVM hemorrhage is incompatible with AVMs present at birth having the same hemorrhage risk as AVMs in adults. Plausibly, they instead develop in the early years of life, possibly with a lower hemorrhage risk during that time period.

Place, publisher, year, edition, pages
American Association of Neurological Surgeons , 2018. Vol. 129, p. 10-16
Keywords [en]
AVM, hemorrhage, risk, vascular disorders, stereotactic radiosurgery
National Category
Neurology
Identifiers
URN: urn:nbn:se:kth:diva-240747DOI: 10.3171/2018.7.GKS181278ISI: 000453374900004PubMedID: 30544301Scopus ID: 2-s2.0-85057737975OAI: oai:DiVA.org:kth-240747DiVA, id: diva2:1276625
Conference
19th International Meeting of the Leksell-Gamma-Knife-Society (LGKS) on Next-Generation Gamma Knife Research, MAR 04-08, 2018, Dubai, U ARAB EMIRATES
Note

QC 20190108

Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-08Bibliographically approved

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Johansson, Arne V.

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