Multiple brain arteriovenous malformations: systematic review and individual patient data meta-analysis.

Multiple brain arteriovenous malformations (bAVM) are rare neurovascular lesions usually related to genetic syndromes. Its management is not well established given its rarity. The objective of this study was to describe the clinical and angiographic features of published cases and to explore their associations with treatment outcomes. We performed a literature search of published cases in Medline and the Regional Index Medici. Additional cases were searched in our single-center registry. Data on the proportions of patients and clinical and angiographic characteristics were extracted. The study outcomes were nidal instability in patients who underwent staged treatment and radiological cure in patients who underwent treatment using any treatment modality. Logistic regression models for the study outcomes were analyzed. Data on the proportions of multiple bAVM patients were summarized with meta-analyses of proportions. We included 118 patients (reported in 68 studies) from the literature and 6 cases identified in our registry. A total of 124 patients harboring 339 bAVM nidi were included in the analyses. Differences between syndromic and non-syndromic cases were observed. The logistic regression analyses showed that angiographically occult untreated bAVM was associated (OR 14.37; 95% CI 2.17 to 95.4) with nidal instability after staged treatment, and deep (OR 5.11; 95% CI 1.51 to 17.27) and eloquent (OR 3.91; 95% CI 1.22 to 12.52) locations were associated with residual disease after treatment. Inconsistent reporting of relevant data throughout the included studies undermined the planned analyses. Some prognostic factors were found to be related to the study outcomes. Study Registration: The protocol of the systematic review was registered in PROSPERO as CRD42021245814.

Es necesario repetir la angiografía cerebral en todos los pacientes con hemorragia subaracnoidea espontánea y primera angiografía negativa, periodo 2009-2014 / It is necessary to repeat the cerebral angiography in all patients with spontaneous subarachnoid hemorrhage and first negative angiography, period 2009-2014

La necesidad de repetir una angiografía cerebral en pacientes con Hemorragia subaracnoidea y angiografía inicial negativa aún sigue siendo debatida, pues hay variabilidad de resultados de las investigaciones realizada de centro a centro y además existe la falta de un metanálisis que concluya mejor los resultados, por ello este estudio es una herramienta para apoyar la protocolización en los centros de salud para el uso adecuado de los procedimientos invasivos para esta serie de casos estudiados. De Octubre del 2009 hasta abril 2014, se presentaron 218 pacientes con hemorragia subaracnoidea, de estos, 39 pacientes (17.89 por ciento) fueron admitidos al estudio por resultar la angiografía cerebral negativa en el Hospital Daniel Alcides Carrión del Callao, siendo distribuidos de acuerdo al patrón de sangrado en la tomografía cerebral de ingreso; se estudió de forma total y parcial las características demográficas, el estado clínico, la efectividad de los exámenes complementarios con sus entidades encontradas, las complicaciones, la evolución clínica del paciente, además se analizó las características de los aneurismas encontrados y que factores contribuyeron que la primera angiografía resultare negativo. De los 39 casos fueron clasificados en cuatro grupos de acuerdo al patrón de sangrado distribuyéndose en 8, 18, 13, 62 por ciento para el patrón negativo, cortical, perimesencefálico y difuso. Así mismo el 32 por ciento de pacientes al realizarse la segunda angiografía resulto positivo, observándose que el patrón perimesencefálico no obtuvo falsos negativos, pero si en los demás patrones de sangrado, siendo el aneurisma cerebral la principal entidad encontrada. Aunque nuestra casuística sigue siendo baja concuerda a la mayoría de trabajos que existe patrones de sangrado que no debería repetirse la angiografía cerebral como son el patrón perimesencefálico, todo lo contrario sucede con los demás patrones, sobretodo se debería buscar el origen aneurismático en los...

The need for repeat cerebral angiography in patients with subarachnoid hemorrhage and negative initial angiography is still debated, as there is variability in results of research conducted on center and there is also a lack of a meta-analysis concluded that best results, therefore this study is a tool to support logging in health centers for appropriate use of invasive procedures for this series of cases studied. From October 2009 to April 2014, 218 patients with subarachnoid hemorrhage, of these, 39 patients ( 17.89 per cent) were admitted to the study prove the negative cerebral angiography in the Hospital Daniel Alcides Carrion in Callao were presented, being distributed according to the pattern bleeding in brain scan at admission; studied fully and partially demographics, clinical status, the effectiveness of complementary examinations found their bodies, complications, clinical course of the patient, the characteristics of the aneurysms was analyzed and found that factors contributed first angiography proves negative. Of the 39 cases were classified into four groups according at the pattern of bleeding, these were distributed in 8, 18, 13, 62 per cent for negative, cortical, perimesencephalic and diffuse pattern. Likewise 32 per cent of patients at the second angiography performed tested positive, showing that the pattern perimesencephalic not get false negatives, but in the other patterns of bleeding, cerebral aneurysm found to be the main entity. Although our cases remains low most consistent work there bleeding patterns that should not be repeated cerebral angiography as are perimesencephalic pattern, the opposite happens with the other patterns, especially should seek aneurysmal origin that bleeds have fuzzy characteristics.