Abstract:
BACKGROUND:An understanding of the present standing of surgery, surgical results and the role in altering the future morbidity and mortality of untreated brain arteriovenous malformations (bAVMs) is appropriate considering the myriad alternative management pathways (including radiosurgery, embolization or some combination of treatments), varying risks and selection biases that have contributed to confusion regarding management. The purpose of this review is to clarify the link between the incidence of adverse outcomes that are reported from a management pathway of either surgery or no intervention with the projected risks of surgery or no intervention. METHODS:A critical review of the literature was performed on the outcomes of surgery and non-intervention for bAVM. An analysis of the biases and how these may have influenced the outcomes was included to attempt to identify reasonable estimates of risks. RESULTS:In the absence of treatment, the cumulative risk of future hemorrhage is approximately 16% and 29% at 10 and 20 years after diagnosis of bAVM without hemorrhage and 35% and 45% at 10 and 20 years when presenting with hemorrhage (annualized, this risk would be approximately 1.8% for unruptured bAVMs and 4.7% for 8 years for bAVMs presenting with hemorrhage followed by the unruptured bAVM rate). The cumulative outcome of these hemorrhages depends upon whether the patient remains untreated and is allowed to have a further hemorrhage or is treated at this time. Overall, approximately 42% will develop a new permanent neurological deficit or death from a hemorrhagic event. The presence of an associated proximal intracranial aneurysm (APIA) and restriction of venous outflow may increase the risk for subsequent hemorrhage. Other risks for increased risk of hemorrhage (age, pregnancy, female) were examined, and their purported association with hemorrhage is difficult to support. Both the Spetzler-Martin grading system (and its compaction into the Spetzler-Ponce tiers) and Lawton-Young supplementary grading system are excellent in predicting the risk of surgery. The 8-year risk of unfavorable outcome from surgery (complication leading to a permanent new neurological deficit with a modified Rankin Scale score of greater than one, residual bAVM or recurrence) is dependent on bAVM size, the presence of deep venous drainage (DVD) and location in critical brain (eloquent location). For patients with bAVMs who have neither a DVD nor eloquent location, the 8-year risk for an unfavorable outcome increases with size (increasing from 1 cm to 6 cm) from 1% to 9%. For patients with bAVM who have either a DVD or eloquent location (but not both), the 8-year risk for an unfavorable outcome increases with the size (increasing from 1 cm to 6 cm) from 4% to 35%. For patients with bAVM who have both a DVD and eloquent location, the 8-year risk for unfavorable outcome increases with size (increasing from 1 cm to 3 cm) from 12% to 38%. CONCLUSION:Patients with a Spetzler-Ponce A bAVM expecting a good quality of life for the next 8 years are likely to do better with surgery in expert centers than remaining untreated. Ongoing research is urgently required on the outcome of management pathways for bAVM.
journal_name
Acta Neurochir (Wien)journal_title
Acta neurochirurgicaauthors
Morgan MK,Davidson AS,Assaad NNA,Stoodley MAdoi
10.1007/s00701-017-3217-xsubject
Has Abstractpub_date
2017-08-01 00:00:00pages
1457-1478issue
8eissn
0001-6268issn
0942-0940pii
10.1007/s00701-017-3217-xjournal_volume
159pub_type
杂志文章,评审abstract:OBJECTIVE:Induced endothelin-1 (ET-1) production and decreased nitric oxide synthase (NOS) bioavailability have been found in aneurysmal subarachnoid hemorrhage (SAH). Atorvastatin is recognized to have pleiotropic effects including increasing NOS bioavailability as well as reducing inflammation and oxidative damage ot...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-010-0652-3
更新日期:2010-08-01 00:00:00
abstract::The clinical findings and operation results in two series of patients with medial prolapse of an intervertebral disc with total or partial occlusion of the spinal canal are reported. In one of the series (30 patients) symptoms of cauda equina compression, with bladder and rectal disturbances, were present, and in the ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01405333
更新日期:1978-01-01 00:00:00
abstract:BACKGROUND:Drain insertion following chronic subdural haematoma (CSDH) evacuation reduces recurrence and improves outcomes. The mechanism of this improvement is uncertain. We assessed whether drains result in improved postoperative imaging, and which radiological factors are associated with recurrence and functional ou...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,多中心研究
doi:10.1007/s00701-020-04356-z
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Glioblastoma (GBM) is the most common and malignant brain tumor in adults. Despite therapeutic advances, almost all patients eventually experience tumor recurrence. Leptomeningeal spread (LMS) is not a rare condition of recurrence. However, the standard management protocol of LMS has not been established. Th...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-015-2344-5
更新日期:2015-04-01 00:00:00
abstract::We retrospectively analysed 13 patients (pts.) treated at the University of Tübingen from 1985 to 1993 to evaluate the results of radiation therapy (XRT) given as an adjuvant to totally or subtotally resected meningiomas. The overall survival was 38% at five years with a probability of relapse of 50% at this time. Rec...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF02187764
更新日期:1995-01-01 00:00:00
abstract:BACKGROUND:The arcade of Struthers has been described as possible cause of compression of the ulnar nerve but several authors and our own experience have doubt cast on its existence. We, therefore, performed an anatomical study to determine whether or not the arcade of Struthers exists. METHODS:Ten arms from fresh fro...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-003-0006-5
更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:Intraventricular chemotherapy via Ommaya reservoir is an important part of the treatment in patients with malignant central nervous system tumors. In these patients, catheter placement can be challenging due to the normal-sized ventricles. METHOD:Intraoperative ultrasound guidance was used for Ommaya reserv...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-021-04719-0
更新日期:2021-01-20 00:00:00
abstract:OBJECTIVES:A number of different image-guided surgical techniques have been developed during the past decade. None of these methods can provide the surgeon with information about the dynamic changes that occur intra-operatively. MATERIAL AND METHOD:The first vertical open 0.5T MRI-scanner for intra-operative MRI-guide...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s007010050325
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:The evolution of pituitary surgery has made it a safe and effective form of treatment; however, risks of inadequate tumor resection, cerebrospinal fluid (CSF) leak, pituitary dysfunction, and vascular injury still exist. The use of intraoperative ultrasonography (IOUS) in pituitary surgery has been well desc...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-020-04674-2
更新日期:2021-01-05 00:00:00
abstract:BACKGROUND:There is no universal management protocol concerning invasive malignant tumors of the scalp with bone and dura mater invasion. The aims of this study were to report and discuss our experience in the management of these forms of tumors. METHODS:We retrospectively reviewed all consecutive patients of microsur...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-020-04525-0
更新日期:2020-12-01 00:00:00
abstract::The authors present the case of a 66-year-old female who developed progressive pulsating exophthalmos, a bruit, and conjunctival chemosis 7 months after a head injury. These symptoms, though highly suspicious of carotid cavernous fistula, were caused by an arteriovenous fistula (AVF) between the inferolateral trunk (I...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-011-1226-8
更新日期:2012-03-01 00:00:00
abstract::To evaluate the operative mortality and morbidity of definitive intracranial microsurgical aneurysm obliteration as a function of timing of early operative intervention and as a function of clinical condition at the acute state, we retrospectively review 164 consecutive patients who underwent surgery within 72 hours f...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01728872
更新日期:1982-01-01 00:00:00
abstract::The brain-type isoenzyme of creatine kinase was determined in serum (S) and cerebrospinal fluid (CSF) in 37 patients with severe head injury, and a correlation was made with the Glasgow coma score and Glasgow outcome score. All patients with normal S-CKBB and CSF-CKBB activities had a coma score of 15, i.e., no neurol...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01418476
更新日期:1985-01-01 00:00:00
abstract::The unusual presentation of Gorham's disease of skull base and cervical spine in a two-year-old female child with radiological signs mimicking those of raised intracranial pressure is discussed. The differential diagnosis consists of skull base tumours, meningitis, osteomyelitis of the base of skull, congenital hydroc...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-005-0806-x
更新日期:2006-08-01 00:00:00
abstract::We describe a case of transsphenoidal deflation of a detachable balloon after embolization of a carotid-cavernous fistula (CCF). The patient developed complete third and sixth nerve palsies immediately after detachable balloon embolization of the CCF, which was considered to be caused by cavernous sinus (CS) compressi...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-006-1072-2
更新日期:2007-02-01 00:00:00
abstract::The use of cold as a therapeutic agent has a long and colorful history. The Edwin Smith Papyrus, the most ancient medical text known, dated 3500 B.C., made numerous references to the use of cold as therapy. Baron de Larrey, a French army surgeon during Napoleon's Russian campaign, packed the limbs in ice prior to ampu...
journal_title:Acta neurochirurgica
pub_type: 历史文章,杂志文章
doi:10.1007/s00701-006-0747-z
更新日期:2006-05-01 00:00:00
abstract::In the last 3.5 years (up to August 1988) out of 450 patients with surgically treated intracranial aneurysms in 100 cases (22%) acute surgery was performed (up to 72 h after SAH). Patients in grade I-III (WFNS scale) were operated upon. In all the cases there were supratentorial aneurysms. CSF drainage during the oper...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01420184
更新日期:1990-01-01 00:00:00
abstract::The indications and results of transsphenoidal surgery for pituitary adenomas are analysed. The advantages and disadvantages of Bromocriptine and radiotherapy are considered. Transsphenoidal surgery does not damage pre-existing pituitary function. It produces excellent results in micro and mesoadenomas, curing about 7...
journal_title:Acta neurochirurgica
pub_type: 传,历史文章,杂志文章
doi:10.1007/BF01435863
更新日期:1988-01-01 00:00:00
abstract::Therapy for vasogenic brain oedema (VBE) is still an unsolved problem. Experimental work with the aim of establishing an oncotherapeutic option is presented. VBE is performed by focal freeze injury in rats. Using a stereotactic head holder hypo- or hyperosmolar human serum albumin is administered via the intraventricu...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01412002
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:The ventro-lateral thalamus is the stereotactic target of choice for severe intention tremor. Nevertheless, the optimal target area has remained controversial, and targeting of the subthalamic area has been suggested to be superior. PATIENTS AND METHODS:Eleven patients with disabling intention tremor of dif...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-007-1230-1
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Cerebrospinal fluid (CSF) drainage has been variably employed to lower intracranial pressure (ICP) in patients with severe head injury. The efficacy of this manoeuvre remains under-explored (Brain Trauma Foundation Recommendation-optional treatment). This work seeks to report the results of CSF drainage via ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-013-1735-8
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:The suprameatal tubercle (SMT) may obscure the neurovascular compression (NVC) in microvascular decompression (MVD) for trigeminal neuralgia (TGN). The aim of this study is to address the necessity of resecting SMT in MVD for TGN. METHODS:We retrospectively analyzed radiological findings of 461 MVDs in pati...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-020-04242-8
更新日期:2020-05-01 00:00:00
abstract::A paraganglioma of cauda equina region is extremely rare and except for secreting tumour, the pre-operative diagnosis of paraganglioma is very difficult. Two cases of non-functional paragangliomas of the cauda equina region are reported, one was attached to the filum terminale and the other to a rootlet looking very m...
journal_title:Acta neurochirurgica
pub_type: 杂志文章,评审
doi:10.1007/s007010050269
更新日期:1999-01-01 00:00:00
abstract::27 cases of cranioplasty with autogenous bone grafts stored in a deep-freezer and autoclaved before use are reported. The results of follow-up for an average period of one year were satisfactory from the standpoint of brain protection and cosmetic reconstruction. A small area of absorption of grafted bone was observed...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01402184
更新日期:1990-01-01 00:00:00
abstract::Vascular endothelium synthesizes mediators which either cause vasorelaxation or vasoconstriction. The purpose of this study is to investigate the role of these mediators in the pathogenesis of cerebral vasospasm. An inhibitor of endothelium-derived relaxing factor is haemoglobin; endothelium removal by triton X-100 an...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01401136
更新日期:1993-01-01 00:00:00
abstract:INTRODUCTION:Desmoid-type fibromatosis (DTF) frequently arises in patients with neuromuscular choristoma (NMC). We hypothesize that NMC-associated DTF occurs in soft tissues innervated by the NMC-affected nerve, and arises from CTNNB1-mutated (myo) fibroblasts within or directly adjacent to the NMC. MATERIALS AND METH...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-019-04178-8
更新日期:2020-05-01 00:00:00
abstract:PURPOSE:Post-traumatic fistulas between the middle meningeal artery and the cranial venous system are extremely rare. We describe clinical presentation and successful endovascular management of a case of post-traumatic fistula between the middle meningeal artery and the sphenoparietal sinus. METHODS:A 53-year-old man ...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-009-0251-3
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:The aims were to investigate the early effects of graded, closed, mild head injury on neurofilament protein (NF160) and microtubule-associated protein-2 (MAP2) and to examine the levels of lipid peroxidation and the impact of mexilitine, inhibitor of lipid peroxidation, pretreatment on tissue damage. MATERIA...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-003-0209-9
更新日期:2004-06-01 00:00:00
abstract:BACKGROUND:Multiple intracranial aneurysms (MIAs) are associated with poorer outcomes after rupture than are single intracranial aneurysms (SIAs). Although the risk factors for intracranial aneurysm rupture have been widely investigated, few studies have focused on MIAs. Thus, the present study aimed to determine wheth...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-016-2826-0
更新日期:2016-07-01 00:00:00
abstract::We present a possible mechanism of intracerebral peritumoural haemorrhage in meningioma based on the clinical data of three of our cases. A meningioma manifesting intracerebral haemorrhage is uncommon and some sporadic case reports have been presented, but without any proven mechanisms. We are presenting three cases o...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s007010050019
更新日期:2000-01-01 00:00:00