Materiały źródłowe

• #1 Central nervous system vascular malformations: A clinical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7886037/

  CNS vascular malformation is an umbrella term that encompasses a wide variety of pathologies, with a wide range of therapeutic and diagnostic importance. […] Advances in neurovascular imaging along with increased utilization of these advances, have resulted in more frequent identification of these lesions. […] This review covers intracranial and spinal cord vascular malformations and discusses syndromes associated with CNS vascular malformations. […] Patients with CNS vascular lesions can present with a variety of presentations from headache and seizure to isolated cranial nerve deficits and progressive motor and sensory alterations. This highlights the importance of high clinical suspicion and early detection to reduce future risk of complications. […] Understanding the pathophysiology, natural history, and characteristics predictive of the risk of rupture are all essential for clinicians when making appropriate therapeutic decisions.

• #2 Central nervous system vascular malformations: A clinical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7886037/

  The current literature reports a 24% annual risk of rupture. […] The strongest predictor for hemorrhage is a history of bleeding in the past, with the estimated 625% annual rebleeding risk within the first five years, with the first year carrying the highest risk. […] If none of these high-risk characteristics are present, the risk of hemorrhage is estimated at less than 1%. […] The annual risk of intracranial hemorrhage is predicted ~12% many studies have assessed variables to predict risk with mixed results. […] The main predictor for postintervention recovery is the preintervention clinical status. Nonetheless, favorable outcomes are commonly seen even in patients with longstanding and severe symptoms. […] Understanding the underlying pathophysiology and differentiating vascular malformations from mimics are the key factors for success in early recognition, timely treatment, and systematic surveillance in such patients. […] Future studies are needed to advance our understanding on pathobiology of CNS vascular malformations in order to develop robust prognostic models for the stratification of high-risk individuals towards applying personalized interventions.

• #3 Central nervous system vascular malformations: A clinical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7886037/

  The current literature reports a 24% annual risk of rupture. […] The strongest predictor for hemorrhage is a history of bleeding in the past, with the estimated 625% annual rebleeding risk within the first five years, with the first year carrying the highest risk. […] If none of these high-risk characteristics are present, the risk of hemorrhage is estimated at less than 1%. […] The annual risk of intracranial hemorrhage is predicted ~12% many studies have assessed variables to predict risk with mixed results. […] The main predictor for postintervention recovery is the preintervention clinical status. Nonetheless, favorable outcomes are commonly seen even in patients with longstanding and severe symptoms. […] Understanding the underlying pathophysiology and differentiating vascular malformations from mimics are the key factors for success in early recognition, timely treatment, and systematic surveillance in such patients. […] Future studies are needed to advance our understanding on pathobiology of CNS vascular malformations in order to develop robust prognostic models for the stratification of high-risk individuals towards applying personalized interventions.

• #4 Cerebral Arteriovenous Malformation from Classification to the Management | IntechOpen

  https://www.intechopen.com/chapters/67582

  The surgical excision of cAVM gives definitive therapy in cAVM patients, radiosurgery is curative in selected cAVM patients and cerebral angiographic embolization is rarely a sole therapy and usually in combination with surgical therapy. […] Spetzler-Martin grading scale classifies surgical risk of removing cAVM according to its size, location and the presence of deep venous drainage. According to S-M grading, surgery is the modality of choice for grade I and II lesions, with radiosurgery as an alternative for small lesions based on location or other vascular anatomic features, while grade IV and V lesions are generally managed conservatively. S-M Supp grading gives a cut-off scale of 6 for operability of cAVM, and it is also a better predictor for post-cAVM excision neurological outcome.

• #5 Cerebral Arteriovenous Malformation from Classification to the Management | IntechOpen

  https://www.intechopen.com/chapters/67582

  The surgical excision of cAVM gives definitive therapy in cAVM patients, radiosurgery is curative in selected cAVM patients and cerebral angiographic embolization is rarely a sole therapy and usually in combination with surgical therapy. […] Spetzler-Martin grading scale classifies surgical risk of removing cAVM according to its size, location and the presence of deep venous drainage. According to S-M grading, surgery is the modality of choice for grade I and II lesions, with radiosurgery as an alternative for small lesions based on location or other vascular anatomic features, while grade IV and V lesions are generally managed conservatively. S-M Supp grading gives a cut-off scale of 6 for operability of cAVM, and it is also a better predictor for post-cAVM excision neurological outcome.

• #6 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/

  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 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.

• #7 Feature Analysis of Predictors Affecting the Nidus Obliteration of Linear Accelerator-Based Radiosurgery for Arteriovenous Malformations Using Explainable Predictive Modeling

  https://www.mdpi.com/2076-3417/13/7/4267

  This study aimed to evaluate prognostic factors associated with nidus obliteration following stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations. […] The prognostic factors affecting nidus obliteration from most to least important were age, nidus size, volume, total prescription dose, and SM grade, using a predictive model. […] The predictive model identified the main contributing factors associated with a prognostic of nidus obliteration from linear accelerator-based SRS for cerebral AVM. It was confirmed that the results, including the prognostic factors, are potentially useful for outcome prediction for patient and treatment. […] Several studies have analyzed various prognostic factors for outcome prediction related to successful occlusion after radiosurgery of cerebral AVM with a conventional machine learning approach.

• #8 Feature Analysis of Predictors Affecting the Nidus Obliteration of Linear Accelerator-Based Radiosurgery for Arteriovenous Malformations Using Explainable Predictive Modeling

  https://www.mdpi.com/2076-3417/13/7/4267

  The major prognostic factors including the size, anatomical location, and SM grade of the lesion used by the authors are important to considered when planning radiosurgery in this study. […] The analysis revealed that nidus size, volume, and total dose, along with other clinical factors, were significant predictors of obliteration. […] For patients with a nidus size ranging from 1.4 to 1.8 cm, the predictive model yielded a high obliteration probability of 76.5%.

• #9 Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review | Stroke and Vascular Neurology

  https://svn.bmj.com/content/6/4/501

  The neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients (89.8%) with a fatality rate of 1.7% in our cohort, which seemed to be favourable. […] Radiological features significantly predicted worsened outcomes. […] The percentage of worsened outcomes significantly increased as the number of prospective haemorrhages increased (from 1.5% (8 of 531, if 0 prospective ictus) to 37.5% (48 of 128, if 1 ictus) and 38.5% (15 of 39, if 1 ictus)). […] The univariately significant risk factors for worsened outcome are lesion size (per 1mm) (relative risk (RR) 2.343, p0.001), crossing the axial point (RR 2.993, p0.001), DVA (RR 1.801, p=0.020) and depth (RR 1.595, p=0.021). […] In the multivariate analysis (Enter method) with adjustment for duration of follow-up, crossing the axial point (RR 2.325, 95% CI 1.332 to 4.060, p=0.003) and DVA (RR 1.776, 95%CI 1.037 to 3.041, p=0.036) were significantly related to worsened neurological outcomes. […] Overall, we performed a pooled analysis of nine studies, and the proportion of improved/unchanged and worsened outcomes was 85.2% (465 of 546) and 14.3% (78 of 546), respectively, which was analogous to our series and appeared more benign than previously thought.

• #10 Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review | Stroke and Vascular Neurology

  https://svn.bmj.com/content/6/4/501

  The neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients (89.8%) with a fatality rate of 1.7% in our cohort, which seemed to be favourable. […] Radiological features significantly predicted worsened outcomes. […] The percentage of worsened outcomes significantly increased as the number of prospective haemorrhages increased (from 1.5% (8 of 531, if 0 prospective ictus) to 37.5% (48 of 128, if 1 ictus) and 38.5% (15 of 39, if 1 ictus)). […] The univariately significant risk factors for worsened outcome are lesion size (per 1mm) (relative risk (RR) 2.343, p0.001), crossing the axial point (RR 2.993, p0.001), DVA (RR 1.801, p=0.020) and depth (RR 1.595, p=0.021). […] In the multivariate analysis (Enter method) with adjustment for duration of follow-up, crossing the axial point (RR 2.325, 95% CI 1.332 to 4.060, p=0.003) and DVA (RR 1.776, 95%CI 1.037 to 3.041, p=0.036) were significantly related to worsened neurological outcomes. […] Overall, we performed a pooled analysis of nine studies, and the proportion of improved/unchanged and worsened outcomes was 85.2% (465 of 546) and 14.3% (78 of 546), respectively, which was analogous to our series and appeared more benign than previously thought.

• #11 Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review | Stroke and Vascular Neurology

  https://svn.bmj.com/content/6/4/501

  The neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients (89.8%) with a fatality rate of 1.7% in our cohort, which seemed to be favourable. […] Radiological features significantly predicted worsened outcomes. […] The percentage of worsened outcomes significantly increased as the number of prospective haemorrhages increased (from 1.5% (8 of 531, if 0 prospective ictus) to 37.5% (48 of 128, if 1 ictus) and 38.5% (15 of 39, if 1 ictus)). […] The univariately significant risk factors for worsened outcome are lesion size (per 1mm) (relative risk (RR) 2.343, p0.001), crossing the axial point (RR 2.993, p0.001), DVA (RR 1.801, p=0.020) and depth (RR 1.595, p=0.021). […] In the multivariate analysis (Enter method) with adjustment for duration of follow-up, crossing the axial point (RR 2.325, 95% CI 1.332 to 4.060, p=0.003) and DVA (RR 1.776, 95%CI 1.037 to 3.041, p=0.036) were significantly related to worsened neurological outcomes. […] Overall, we performed a pooled analysis of nine studies, and the proportion of improved/unchanged and worsened outcomes was 85.2% (465 of 546) and 14.3% (78 of 546), respectively, which was analogous to our series and appeared more benign than previously thought.

• #12 Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review | Stroke and Vascular Neurology

  https://svn.bmj.com/content/6/4/501

  The neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients (89.8%) with a fatality rate of 1.7% in our cohort, which seemed to be favourable. […] Radiological features significantly predicted worsened outcomes. […] The percentage of worsened outcomes significantly increased as the number of prospective haemorrhages increased (from 1.5% (8 of 531, if 0 prospective ictus) to 37.5% (48 of 128, if 1 ictus) and 38.5% (15 of 39, if 1 ictus)). […] The univariately significant risk factors for worsened outcome are lesion size (per 1mm) (relative risk (RR) 2.343, p0.001), crossing the axial point (RR 2.993, p0.001), DVA (RR 1.801, p=0.020) and depth (RR 1.595, p=0.021). […] In the multivariate analysis (Enter method) with adjustment for duration of follow-up, crossing the axial point (RR 2.325, 95% CI 1.332 to 4.060, p=0.003) and DVA (RR 1.776, 95%CI 1.037 to 3.041, p=0.036) were significantly related to worsened neurological outcomes. […] Overall, we performed a pooled analysis of nine studies, and the proportion of improved/unchanged and worsened outcomes was 85.2% (465 of 546) and 14.3% (78 of 546), respectively, which was analogous to our series and appeared more benign than previously thought.

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

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

  In 2014, ARUBA (a randomized trial on cerebral Arteriovenous Malformation AVM) found patients treated using prevalent interventional strategies are three times more likely to suffer a stroke/die compared with those treated conservatively (blood pressure reduction). […] A clear accord emerges. There is, indeed, a lacuna or at least weakness of interventional modalities when addressing high SM grade AVMs. […] To conclude, many patients with cerebral AVM benefit less from current prevalent treatment modalities that carry high risks, costs, and intensive procedures and, even if eventually effective, take years to complete. […] 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.

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

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

  In 2014, ARUBA (a randomized trial on cerebral Arteriovenous Malformation AVM) found patients treated using prevalent interventional strategies are three times more likely to suffer a stroke/die compared with those treated conservatively (blood pressure reduction). […] A clear accord emerges. There is, indeed, a lacuna or at least weakness of interventional modalities when addressing high SM grade AVMs. […] To conclude, many patients with cerebral AVM benefit less from current prevalent treatment modalities that carry high risks, costs, and intensive procedures and, even if eventually effective, take years to complete. […] 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.

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

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

  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 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. […] 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). […] The two leading avenues of interventional choice for medium-to-large lesions are currently multi-modal and staged treatment. […] If proven feasible, low-radiation implants could add several unique benefits to AVM treatment and we advocate studying their use.

• #16

  https://journals.lww.com/brci/fulltext/2022/08030/presentation_and_management_of_nervous_system.2.aspx

  Cerebral cavernous malformations (CMs) are slow-flow vascular lesions that affect up to 0.5% of the pediatric population. These lesions are at risk for hemorrhage, causing seizures, and leading to neurological deficits. […] Our analysis of published literature shows surgical intervention should be considered first-line therapy for patients who are symptomatic from CM, present with seizure, and have surgically accessible lesions. […] Pediatric patients are known to have increased brain plasticity compared to adult patients, and can have a successful recovery even if immediate surgical morbidity occurs. Indeed, in patients treated with stereotactic radiosurgery, hemorrhage-free survival is markedly better in children compared to adults. […] Our pooled analysis revealed that 85.2% of patients who had epilepsy were Engel Class 1 after surgery. Over a mean follow-up of 4.1 years, only 3.4% of patients had additional neurological deficits, including paresis and speech deficits.

• #17

  https://journals.lww.com/brci/fulltext/2022/08030/presentation_and_management_of_nervous_system.2.aspx

  Cerebral cavernous malformations (CMs) are slow-flow vascular lesions that affect up to 0.5% of the pediatric population. These lesions are at risk for hemorrhage, causing seizures, and leading to neurological deficits. […] Our analysis of published literature shows surgical intervention should be considered first-line therapy for patients who are symptomatic from CM, present with seizure, and have surgically accessible lesions. […] Pediatric patients are known to have increased brain plasticity compared to adult patients, and can have a successful recovery even if immediate surgical morbidity occurs. Indeed, in patients treated with stereotactic radiosurgery, hemorrhage-free survival is markedly better in children compared to adults. […] Our pooled analysis revealed that 85.2% of patients who had epilepsy were Engel Class 1 after surgery. Over a mean follow-up of 4.1 years, only 3.4% of patients had additional neurological deficits, including paresis and speech deficits.

• #18

  https://journals.lww.com/brci/fulltext/2022/08030/presentation_and_management_of_nervous_system.2.aspx

  Cerebral cavernous malformations (CMs) are slow-flow vascular lesions that affect up to 0.5% of the pediatric population. These lesions are at risk for hemorrhage, causing seizures, and leading to neurological deficits. […] Our analysis of published literature shows surgical intervention should be considered first-line therapy for patients who are symptomatic from CM, present with seizure, and have surgically accessible lesions. […] Pediatric patients are known to have increased brain plasticity compared to adult patients, and can have a successful recovery even if immediate surgical morbidity occurs. Indeed, in patients treated with stereotactic radiosurgery, hemorrhage-free survival is markedly better in children compared to adults. […] Our pooled analysis revealed that 85.2% of patients who had epilepsy were Engel Class 1 after surgery. Over a mean follow-up of 4.1 years, only 3.4% of patients had additional neurological deficits, including paresis and speech deficits.

• #19

  https://journals.lww.com/brci/fulltext/2022/08030/presentation_and_management_of_nervous_system.2.aspx

  Cerebral cavernous malformations (CMs) are slow-flow vascular lesions that affect up to 0.5% of the pediatric population. These lesions are at risk for hemorrhage, causing seizures, and leading to neurological deficits. […] Our analysis of published literature shows surgical intervention should be considered first-line therapy for patients who are symptomatic from CM, present with seizure, and have surgically accessible lesions. […] Pediatric patients are known to have increased brain plasticity compared to adult patients, and can have a successful recovery even if immediate surgical morbidity occurs. Indeed, in patients treated with stereotactic radiosurgery, hemorrhage-free survival is markedly better in children compared to adults. […] Our pooled analysis revealed that 85.2% of patients who had epilepsy were Engel Class 1 after surgery. Over a mean follow-up of 4.1 years, only 3.4% of patients had additional neurological deficits, including paresis and speech deficits.

• #20

  https://journals.lww.com/brci/fulltext/2022/08030/presentation_and_management_of_nervous_system.2.aspx

  For patients who do not undergo surgery after the first presentation, the risk for future hemorrhage and neurological sequela remains. A study on prospective hemorrhage risk found that the annual rates of hemorrhage for: patients initially presenting with hemorrhage, patients with symptoms not related to hemorrhage, and patients with CM as an incidental finding were 6%, 2%, and 0.3%, respectively.

• #21 Central nervous system vascular malformations: A clinical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7886037/

  The current literature reports a 24% annual risk of rupture. […] The strongest predictor for hemorrhage is a history of bleeding in the past, with the estimated 625% annual rebleeding risk within the first five years, with the first year carrying the highest risk. […] If none of these high-risk characteristics are present, the risk of hemorrhage is estimated at less than 1%. […] The annual risk of intracranial hemorrhage is predicted ~12% many studies have assessed variables to predict risk with mixed results. […] The main predictor for postintervention recovery is the preintervention clinical status. Nonetheless, favorable outcomes are commonly seen even in patients with longstanding and severe symptoms. […] Understanding the underlying pathophysiology and differentiating vascular malformations from mimics are the key factors for success in early recognition, timely treatment, and systematic surveillance in such patients. […] Future studies are needed to advance our understanding on pathobiology of CNS vascular malformations in order to develop robust prognostic models for the stratification of high-risk individuals towards applying personalized interventions.

• #22 Central nervous system vascular malformations: A clinical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7886037/

  The current literature reports a 24% annual risk of rupture. […] The strongest predictor for hemorrhage is a history of bleeding in the past, with the estimated 625% annual rebleeding risk within the first five years, with the first year carrying the highest risk. […] If none of these high-risk characteristics are present, the risk of hemorrhage is estimated at less than 1%. […] The annual risk of intracranial hemorrhage is predicted ~12% many studies have assessed variables to predict risk with mixed results. […] The main predictor for postintervention recovery is the preintervention clinical status. Nonetheless, favorable outcomes are commonly seen even in patients with longstanding and severe symptoms. […] Understanding the underlying pathophysiology and differentiating vascular malformations from mimics are the key factors for success in early recognition, timely treatment, and systematic surveillance in such patients. […] Future studies are needed to advance our understanding on pathobiology of CNS vascular malformations in order to develop robust prognostic models for the stratification of high-risk individuals towards applying personalized interventions.

• #23 Feature Analysis of Predictors Affecting the Nidus Obliteration of Linear Accelerator-Based Radiosurgery for Arteriovenous Malformations Using Explainable Predictive Modeling

  https://www.mdpi.com/2076-3417/13/7/4267

  This study aimed to evaluate prognostic factors associated with nidus obliteration following stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations. […] The prognostic factors affecting nidus obliteration from most to least important were age, nidus size, volume, total prescription dose, and SM grade, using a predictive model. […] The predictive model identified the main contributing factors associated with a prognostic of nidus obliteration from linear accelerator-based SRS for cerebral AVM. It was confirmed that the results, including the prognostic factors, are potentially useful for outcome prediction for patient and treatment. […] Several studies have analyzed various prognostic factors for outcome prediction related to successful occlusion after radiosurgery of cerebral AVM with a conventional machine learning approach.

• #24 Feature Analysis of Predictors Affecting the Nidus Obliteration of Linear Accelerator-Based Radiosurgery for Arteriovenous Malformations Using Explainable Predictive Modeling

  https://www.mdpi.com/2076-3417/13/7/4267

  This study aimed to evaluate prognostic factors associated with nidus obliteration following stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations. […] The prognostic factors affecting nidus obliteration from most to least important were age, nidus size, volume, total prescription dose, and SM grade, using a predictive model. […] The predictive model identified the main contributing factors associated with a prognostic of nidus obliteration from linear accelerator-based SRS for cerebral AVM. It was confirmed that the results, including the prognostic factors, are potentially useful for outcome prediction for patient and treatment. […] Several studies have analyzed various prognostic factors for outcome prediction related to successful occlusion after radiosurgery of cerebral AVM with a conventional machine learning approach.

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

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

  In 2014, ARUBA (a randomized trial on cerebral Arteriovenous Malformation AVM) found patients treated using prevalent interventional strategies are three times more likely to suffer a stroke/die compared with those treated conservatively (blood pressure reduction). […] A clear accord emerges. There is, indeed, a lacuna or at least weakness of interventional modalities when addressing high SM grade AVMs. […] To conclude, many patients with cerebral AVM benefit less from current prevalent treatment modalities that carry high risks, costs, and intensive procedures and, even if eventually effective, take years to complete. […] 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.

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