1. Outcomes of Unruptured Low-Grade Brain Arteriovenous Malformations Using TOBAS (Treatment of Brain Arteriovenous Malformations Study) Criteria.
- Author
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Dumot C, Picart T, Eker O, Guyotat J, Berhouma M, and Pelissou-Guyotat I
- Subjects
- Adult, Humans, Treatment Outcome, Rupture, Spontaneous surgery, Brain, Retrospective Studies, Intracranial Arteriovenous Malformations diagnostic imaging, Intracranial Arteriovenous Malformations therapy, Intracranial Arteriovenous Malformations complications, Embolization, Therapeutic methods, Stroke surgery, Nervous System Malformations surgery, Radiosurgery methods
- Abstract
Background: Treatment of an unruptured brain arteriovenous malformation (bAVM) is a matter of debate, especially for low-grade bAVM (Spetzler-Martin grade I and II). The aim is to compare the outcomes of patients with low-grade unruptured bAVM after interventional or medical management in a pragmatic manner., Methods: Adults with unruptured low-grade bAVM diagnosed between 2006 and 2016 were included. The primary end points were death from all causes and disabling stroke that resulted in a modified Rankin Scale (mRS) score >2 at last follow-up., Results: Eighty-four patients presented with an unruptured Spetzler-Martin low-grade bAVM. Among these patients, 55 (65.5%) were treated and 29 (34.5%) were untreated, with no differences regarding clinical and radiologic characteristics. The modality of treatment was embolization in 25.5%, radiosurgery (alone, 30.9%; with embolization, 18.2%), and surgery (alone, 5.5%; with embolization, 20%). The rupture rate was 6.7% person-year in the untreated group; 12.7% (n = 7) of treated and 16.7% (n = 5) of untreated patients achieved the primary evaluation criteria (P = 0.744). Using a Kaplan-Meier curve, the probability of reaching this criterion at 5 years was not different between groups (P = 0.07). Complications resulting in an mRS score >2 at last follow-up occurred in 9.1%, in 80% of cases after embolization., Conclusions: This study shows no differences between treated and untreated low-grade bAVM. Embolization seems to carry a high risk of complication and should be used with caution. The small number of cases must encourage cautious interpretations especially because of the spontaneous high-rupture rate. One major interest is to investigate center habits in pathology when treatment standards are limited., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
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