Materiały źródłowe

• #1 Brain Arteriovenous Malformations Classifications: A Surgical Point of View | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-63453-7_15

  Brain arteriovenous malformations (AVMs) classification has been the subject of extensive discussion. […] specific classifications that evaluate the outcome and the predictability of obliteration of other treatment modalities and others that evaluate the outcome of intracerebral hemorrhages in ruptured AVMs. […] Patient selection should therefore weigh the natural history of AVMs against treatment-related risks. It is a difficult process complicated by the variety of angioarchitecture, size, location, and clinical features of AVMs. It is, however, the key to achieving a good outcome. […] Clinical factors negatively correlated with the outcome are the advanced age, the presence of neurological deficits or an alteration of the state of consciousness at the time of treatment, and the presence of a previous bleeding.

• #1 Compva: Prognosis — Arteriovenous malformation

  https://www.compva.com/science/prognosis-arteriovenous-malformation

  An untreated arteriovenous malformation often has a poor prognosis as a result of the slow but often continuous progression of the disease and the permanent increase in volume and pressure load on the arteries and veins involved. […] The appropriate time for treatment of the arteriovenous malformation depends on its Schobinger stage (therapy usually begins at Schobinger II to III). […] In the treatment of an asymptomatic or stable, quiescent arteriovenous malformation, possible complications may outweigh the benefits of the treatment. […] Especially incomplete attempts at open resection of an arteriovenous malformation should be avoided.

• #1 A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11571210/

  By systematically reviewing the literature, we have found that there is very little information about the frequency and clinical course of arteriovenous malformations (AVMs) of the brain in adults because the methods of most studies have been flawed, and AVMs tend to be treated once they are discovered. […] The limited high quality data available on prognosis suggest that long-term crude annual case fatality is 1-1.5%, the crude annual risk of first occurrence of haemorrhage from an unruptured AVM is approximately 2%, but the risk of recurrent haemorrhage may be as high as 18% in the first year, with uncertainty about the risk thereafter. […] For untreated AVMs, the annual risk of developing de novo seizures is 1%. There is a pressing need for large, prospective studies of the frequency and clinical course of AVMs in well-defined, stable populations, taking account of their prognostic heterogeneity.

• #1 Outcome of 107 conservatively managed unruptured brain arteriovenous malformations: a single center’s 30-year experience in: Journal of Neurosurgery Volume 139 Issue 4 (2023) Journals

  https://thejns.org/view/journals/j-neurosurg/139/4/article-p1025.xml

  The authors results represent the long-term course of unruptured untreated bAVMs. Their data support the conclusion that even in the post-ARUBA era, tailored active treatment options may be offered to patients with unruptured bAVMs. […] The long-term follow-up AVM-related mortality rate amounted to 8%. […] The estimated median overall survival after AVM diagnosis was 19.3 years (95% CI 14.0-24.6 years). […] A multivariate Cox regression model revealed temporal and deep-seated localization as an independent risk factor for AVM hemorrhage, while the presence of seizures reached borderline significance as a risk factor. […] In contrast to the ARUBA study’s 0% mortality in the medical management arm, the long-term follow-up AVM-related mortality rate amounted to an unacceptable 8% among conservatively managed AVMs in our cohort. […] Even in the post-ARUBA era, active treatment options should be offered to patients with unruptured bAVMs. Tailored patient counseling should weigh the natural course of unruptured bAVMs against specific treatment-associated complication rates.

• #1 Advocating Intraluminal Radiation Therapy in Cerebral Arteriovenous Malformation Treatment | IntechOpen

  https://www.intechopen.com/chapters/69610

  The lack of clear treatment choice for a pathology with a point prevalence of ~18/100,000 in adults responsible for 4% of all primary intracerebral hemorrhages is the motivation for this review. […] The SM grading system for predicting patient outcome is microsurgery-based and remains the gold standard in the field. […] The main advantage of AVM microsurgery is its straightforward approach, which allows relatively definite lesion resection and rapid clear follow-up. […] The subject of lesion recurrence following microsurgery has been controversial. Different centers report highly varied outcomes. […] The ARUBA trial, published in 2014, compared interventional therapy with medical management of unruptured brain AVMs. […] One clear consensus emergesfurther research is advocated to delineate the optimal management of unruptured AVMs, particularly those with SM grade3.

• #1 Brain Arteriovenous Malformations Classifications: A Surgical Point of View | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-63453-7_15

  The grade of the AVM was derived from the sum of the scores assigned for each category. […] The predictive power on surgical outcome was identical to the original classification. […] The authors generally recommended surgical treatment for grade A AVMs, multimodal treatment for grade B, and observation for grade C, reserving treatment for cases of recurrent hemorrhages or progressive neurological deficits due to blood steal phenomena. […] The proposed score included the sum of the scores obtained from factors derived from the S-M scale and the Lawton-Young grading system (size, deep drainage, eloquent area, age, compactness of the nidus) and from factors derived from the ICH Score. […] Prognosis may then be more linked to the angioarchitectural features of the AVM than to the ICH itself.

• #1 Outcome prediction for treatment of brain arteriovenous malformations: performance of endovascular predictive scores in a single-center population – PubMed

  https://pubmed.ncbi.nlm.nih.gov/40139784/

  Outcome prediction for treatment of brain arteriovenous malformations: performance of endovascular predictive scores in a single-center population […] Background: Endovascular embolization is an accepted treatment modality for brain arteriovenous malformations (bAVM); however, treatment outcomes are highly variable, warranting accurate prediction for adequate patient selection. Several predictive scores have been proposed for this purpose. The objective of this study was to externally validate these scores for embolization of bAVM. […] Methods: This study involved bAVM patients treated with transarterial embolization. Endovascular predictive scores were identified through literature search. Relevant data for scoring of included patients was extracted. Primary study outcomes were radiological cure and neurological complications. The performance of the scores was evaluated by analyzing calibration (z-scores from logistic regression), discrimination (area under the receiver operating characteristic curve, AUROC), and classification (Youden’s index and corresponding sensitivity and specificity). Additionally, sensitivity analyses were performed restricting the study population by size, location, and embolization intent.

• #1 Outcome prediction for treatment of brain arteriovenous malformations: performance of endovascular predictive scores in a single-center population – PubMed

  https://pubmed.ncbi.nlm.nih.gov/40139784/

  Results: A total of 198 bAVM (190 patients) were included. The rates of radiological cure and neurological complications were 18.2% and 14.1%, respectively. The literature search identified seven predictive scores. In the overall analysis, the Toronto score showed the best performance for radiological cure (AUROC 0.905). No significant difference was observed between the performance of the assessed scores for neurological complications. The sensitivity analysis showed improved performance of most scores. The Toronto score exhibited the highest performance for radiological cure (AUROC 0.857). The AVM Embolization Prognostic Risk Score (AVMEPRS) showed the highest performance for neurological complications (AUROC 0.751). The AVM Embocure Score (AVMES) showed fair to good performance for both efficacy and safety outcomes. […] Conclusion: Among the selected scores, the Toronto, AVMEPRS, and AVMES scores showed the best performances.

• #1 Brain arteriovenous malformations of the middle cerebral artery region: image characteristics and endovascular treatment based on a new classification system | BMC Neurology | Full Text

  https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03084-y

  The present study demonstrated that the new classification of MCA-BAVMs can be used to evaluate the imaging characteristics and EVT outcomes in different types. In addition, EVT may be a safe treatment modality for MCA-BAVMs. […] A good outcome was defined as GOS scores of 4 and 5. […] At discharge, a good outcome with GOS scores of 4 and 5 was observed in 97% (131/135) of patients, and 3% (4/135) of patients had a GOS score of 3.

• #1 Surgical Treatment of Unruptured Brain AVMs: Short- and Long-Term Results | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-63453-7_13

  Unruptured brain AVMs (bAVMs) remain a controversial subject for practicing neurosurgeons, especially in the light of ARUBA and other observational studies. […] The study comprised 160 adult patients with unruptured bAVMs surgically treated in Burdenko NMC (Moscow) in 20092017. […] Good outcomes (mRS = 02) at discharge were achieved in 149 (93.1%), satisfactory (mRS3)9 (5.6%). […] Excellent outcomes (mRS = 01) reached in 94.8%. […] Overall, our results support the conclusion that surgery for low-grade bAVMs (S-M III) is a beneficial, low-risk option. […] The long-term treatment outcomes were evaluated in 97 (60.6%) patients. […] At follow-up, the number of patients with excellent outcomes (mRS = 01) increased to 80.4%, and the total number of favorable outcomes (mRS = 02) reached 94.8%.

• #1 Surgical Treatment of Unruptured Brain AVMs: Short- and Long-Term Results | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-030-63453-7_13

  According to our data, favorable outcomes were achieved in 84.8% of patients (Engel class I) with complete seizures relieved (Engel class IA) in 64%. […] AVM resection does not ensure full seizure resolution; therefore, we recommend continuation of anticonvulsants for 612 months. […] According to the published reports, surgical resection of AVM led to headache intensity decrease or complete resolution in 3383% of patients. […] In our series, 66% of patients demonstrated various degrees of improvement. […] Functional outcomes in our study are consistent with the published data confirming that surgery for low-grade AVMs is reasonably safe and not associated with major neurological complications.

• #1 Using a Machine Learning Approach to Predict Outcomes after Radiosurgery for Cerebral Arteriovenous Malformations | Scientific Reports

  https://www.nature.com/articles/srep21161

  The median time to a favorable outcome was 4.2 years. At all follow-up time points, the LR predictor had superior AUC compared to the VRAS, SM grade, and RBAS. The LR predictor delivered superior predictive accuracy compared to existing clinical models with an AUC of 0.70 at four years, which was relatively constant at all times points. […] For patients predicted to have an unfavorable outcome at eight years, there was a trend towards a higher rate of post-radiosurgery hemorrhage compared to the favorable outcome group. A greater average 3D surface dose was delivered to patients who experienced a post-radiosurgery hemorrhage and to patients who suffered a permanent neurological deficit. […] This study demonstrates a machine learning approach towards medical prognostication, specifically, a novel method for predicting AVM radiosurgery outcomes. The application of machine learning methods to medical data constitutes the analytical backbone of a novel research paradigm. The novel predictors described by the present study, particularly our LR predictor, have a radically different design process.

• #1 Advocating Intraluminal Radiation Therapy in Cerebral Arteriovenous Malformation Treatment | IntechOpen

  https://www.intechopen.com/chapters/69610

  We feel that one possible cause is the limitations inherent in present approaches that lead to diminishing returns with every new improvement (necessitating ever-increasing technological and financial investments). […] To conclude, we fear that multi-modal treatment faces inherent financial and technical limitations that strongly impede its chances of reaching full potential and will continue to do so in the near future. […] If proven feasible, low-radiation implants could add several unique benefits to AVM treatment and we advocate studying their use.

• #1 Using a Machine Learning Approach to Predict Outcomes after Radiosurgery for Cerebral Arteriovenous Malformations | Scientific Reports

  https://www.nature.com/articles/srep21161

  Variability in patient outcomes after a given therapy is a known part of medical practice. Machine learning presents novel tools to predict outcomes and, in the case of AVM radiosurgery, can provide a powerful tool for treatment planning. This approach towards developing optimal predictors has enabled the present study to create a tool that outperforms existing prognostic systems for predicting AVM outcomes.

• #2 Using a Machine Learning Approach to Predict Outcomes after Radiosurgery for Cerebral Arteriovenous Malformations | Scientific Reports

  https://www.nature.com/articles/srep21161

  Predictions of patient outcomes after a given therapy are fundamental to medical practice. We employ a machine learning approach towards predicting the outcomes after stereotactic radiosurgery for cerebral arteriovenous malformations (AVMs). The best predictor had an average area under the curve (AUC) of 0.71 compared to existing clinical systems of 0.63 across all time points. This machine learning approach was able to provide the best possible predictions of AVM radiosurgery outcomes of any method to date, identify a novel radiobiological feature (3D surface dose), and demonstrate a paradigm for further development of prognostic tools in medical care. […] Predicting the outcome of a specific patient treated with a particular therapy is fundamental to medical practice. In the case of cerebral arteriovenous malformations (AVMs), several scoring systems have been developed to augment clinician experience in predicting individual patient outcomes after treatment with radiosurgery. The degree to which we can improve upon currently available classification systems for predicting AVM treatment outcomes is unknown.

• #2 Outcome prediction for treatment of brain arteriovenous malformations: performance of endovascular predictive scores in a single-center population | Journal of NeuroInterventional Surgery

  https://jnis.bmj.com/content/early/2025/03/26/jnis-2024-022927

  Endovascular embolization is an accepted treatment modality for brain arteriovenous malformations (bAVM); however, treatment outcomes are highly variable, warranting accurate prediction for adequate patient selection. […] The objective of this study was to externally validate these scores for embolization of bAVM. […] The rates of radiological cure and neurological complications were 18.2% and 14.1%, respectively. […] In the overall analysis, the Toronto score showed the best performance for radiological cure (AUROC 0.905). […] The sensitivity analysis showed improved performance of most scores. […] The Toronto score exhibited the highest performance for radiological cure (AUROC 0.857). […] The AVM Embolization Prognostic Risk Score (AVMEPRS) showed the highest performance for neurological complications (AUROC 0.751). […] Among the selected scores, the Toronto, AVMEPRS, and AVMES scores showed the best performances.

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