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2.
Medicine (Baltimore) ; 99(3): e18873, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011512

RESUMO

RATIONALE: Trigeminal neuralgia (TN) is frequently associated with compression at the root entry zone of the trigeminal nerve by an aberrant loop of an artery, tributaries of the petrosal vein, tumors, aneurysm, and vascular malformation. TN associated with a cerebellar pial arteriovenous fistula (PAVF) has not been described previously. PATIENT CONCERNS: A 65-year-old man presented with right-sided TN. Cerebral angiography revealed a right cerebellar PAVF and magnetic resonance imaging demonstrated a mixed compression of the petrous vein complex and anterior inferior cerebellar artery at the right trigeminal nerve. DIAGNOSIS: Due to the patient's symptoms, radiographic findings, he was diagnosed with TN and PAVF. INTERVENTIONS: Coiling combined with use of the liquid embolic agent Onyx was used for the complete embolization of the fistula. OUTCOMES: Complete relief of the pain was achieved 3 months after endovascular treatment, and the patient has remained pain-free during 2 years of follow-up. CONCLUSIONS: Endovascular treatment with a combination of coils and Onyx embolization is an effective approach for complete resolution of rarely occurring TN caused by mixed venous and arterial compressions associated with cerebellar PAVF.


Assuntos
Malformações Arteriovenosas Intracranianas/complicações , Neuralgia do Trigêmeo/etiologia , Idoso , Angiografia Cerebral , Embolização Terapêutica , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/terapia , Imagem por Ressonância Magnética , Masculino , Pia-Máter/diagnóstico por imagem , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/terapia
3.
No Shinkei Geka ; 48(1): 39-45, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31983687

RESUMO

We herein report a case of ruptured arterio-venous malformation(AVM)detected using three-dimensional digital subtraction angiography(3DDSA)fusion images and successfully treated with target embolization for pseudoaneurysm. A 50-year-old man with a history of AVM was admitted to our department for the treatment of ruptured high-grade AVM in the right parietal lobe. Although a bleeding point was not evident on DSA, the patient had re-rupture in the right ventricle, one month after admission. Chronological 3DDSA fusion images generated from 3DDSA images taken on admission and after re-rupture revealed a newly visualized intranidal pseudoaneurysm near a hematoma. Contrast-enhanced magnetic resonance imaging showed vessel wall enhancement along the posterior horn of the right ventricle;this enhancement corresponded to the location of the pseudoaneurysm. We planned target embolization for the intranidal pseudoaneurysm to prevent re-bleeding. The origin of the feeder was so steep that a microcatheter could not be advanced deeply, and embolization with 20% n-butyl-2-cyanoacrylate resulted in proximal occlusion. Follow-up angiography 1 week after embolization showed complete disappearance of the pseudoaneurysm, and the patient had no recurrence of aneurysm until one year.


Assuntos
Falso Aneurisma , Aneurisma Roto , Embolização Terapêutica , Malformações Arteriovenosas Intracranianas , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Aneurisma Roto/diagnóstico , Aneurisma Roto/terapia , Angiografia Digital , Humanos , Imagem Tridimensional , Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/terapia , Masculino , Pessoa de Meia-Idade
4.
World Neurosurg ; 133: e197-e204, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31491572

RESUMO

OBJECTIVE: To evaluate the functional connectivity (FC) and resting-state networks (RSNs) in patients under anesthesia operated for resection of intracerebral lesions. METHODS: We performed intraoperative resting-state functional magnetic resonance imaging (irs-fMRI) in 24 patients under anesthesia before and after lesion resection. Correlation matrices were established for each session (a total 48 of sessions). We analyzed the changes in overall FC and in FC of the healthy and operated hemispheres between the first and second sessions. We tested the correlation between changes in FC and clinical outcomes and the duration, rate, and total dosage of anesthesia. We also performed a group analysis to detect topographic changes in RSNs in patients under anesthesia. A single-subject analysis was performed to detect clinically relevant RSNs in each patient. RESULTS: FC decreased significantly in the second session, as did interhemispheric connectivity. The decrease in the pathological hemisphere was significant and significantly greater than the decrease in the intrahemispheric connectivity of the healthy hemisphere. The change in FC was not correlated with clinical outcome or with the duration, rate, or dosage of anesthesia. Group analysis showed topographic changes in RSNs, especially in high-level networks such as default mode and salience networks. Identification of clinically relevant networks was also possible. CONCLUSIONS: FC and RSNs could be identified under anesthesia and used for extended brain mapping. Further studies are needed to optimize the depth of hypnosis to stabilize FC between sessions.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Conectoma/métodos , Glioma/diagnóstico por imagem , Hemangioma Cavernoso/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neuronavegação/métodos , Radiografia Intervencionista/métodos , Cirurgia Assistida por Computador , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/cirurgia , Pré-Escolar , Feminino , Glioma/cirurgia , Hemangioma Cavernoso/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
World Neurosurg ; 135: 96-99, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31841721

RESUMO

BACKGROUND: Endovascular embolization is being increasingly used to treat cerebral arteriovenous malformations. Common complications associated with embolization include intracranial hemorrhage and ischemic stroke; intracranial infections seldomly occur and are even less frequently reported. Although abscess formation after embolization is exceedingly rare, it is a serious condition that warrants immediate attention. CASE DESCRIPTION: This 53-year-old male with a ruptured left temporal-occipital arteriovenous malformation. He underwent uncomplicated 2-stage embolization with Onyx and was discharged. Five weeks after embolization, he returned to the hospital with worsening aphasia and contralateral hemiparesis, and a cerebral abscess was detected at the site of embolization. Bacterial cultures were positive for Escherichia coli, and he was treated successfully with surgical excision of the abscess and Onyx material, followed by long-term antibiotics. CONCLUSIONS: Although rare, formation of an intracranial abscess after endovascular embolization is a potential complication in the treatment of arteriovenous malformations.


Assuntos
Abscesso Encefálico/etiologia , Embolização Terapêutica , Malformações Arteriovenosas Intracranianas/terapia , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/terapia , Procedimentos Endovasculares , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
8.
World Neurosurg ; 135: 63-67, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31841722

RESUMO

BACKGROUND: While prior studies reporting de novo arteriovenous malformations after birth are not uncommon, reports of ectopic recurrence of arteriovenous malformation after radiotherapy are scarce. CASE DESCRIPTION: An 8-year-old girl with a ruptured cerebellar arteriovenous malformation was treated with stereotactic radiosurgery. The nidus was completely obliterated 17 months after stereotactic radiosurgery; however, 20 years later she had a rupture of a recurrent nidus that occurred adjacent to the original nidus, accompanied by a radiation-induced cyst. Surgical resection was performed, and subsequent pathologic examination revealed 2 different compartments: a typical nidus and a postirradiated degenerated nidus with an encapsulated hematoma. Immunohistochemical stains showed increased expression of Ki-67 and decreased expression of endoglin in endothelial cells in the recurrent nidus. CONCLUSIONS: Depletion in endoglin may lead to the formation of vessel malformations in the presence of angiogenic stimuli. This case serves as a strong reminder of the importance of long-term follow-up after stereotactic radiosurgery, especially for pediatric cases.


Assuntos
Malformações Arteriovenosas Intracranianas/etiologia , Malformações Arteriovenosas Intracranianas/terapia , Radiocirurgia , Adulto , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Feminino , Hematoma/etiologia , Hematoma/patologia , Hematoma/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/patologia , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/cirurgia , Recidiva , Ruptura Espontânea/etiologia , Ruptura Espontânea/patologia , Ruptura Espontânea/radioterapia
9.
No Shinkei Geka ; 47(12): 1281-1287, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31874950

RESUMO

BACKGROUND: Patients with hereditary hemorrhagic telangiectasia(HHT)are known to have high rates of cerebral arteriovenous malformations(AVMs). Compared to patients with sporadic AVMs, patients with HHT are less likely to present with ruptured AVMs. CASE REPORT: A 14-year-old male patient presented with headache that had lasted for 2 days. CT revealed an intracerebral hemorrhage in the right parietal lobe, and enhanced CT revealed an AVM in the upper part of the hematoma. The size of the nidus was 20 mm, and its feeders were the right superior internal parietal artery and a branch of the anterior cerebral artery. In addition, the AVM had no deep drainer. We also found another AVM in the right temporal lobe and identified telangiectasia of the nose using digital subtraction angiography. We suspected HHT and performed whole body CT, which revealed an arteriovenous fistula in the right lung and a hematoma-like lesion in the spleen. Thus, we diagnosed the patient with HHT. His ruptured AVM was removed electively. CONCLUSION: We report a case of HHT that presented as an intracerebral hemorrhage in a patient. Based on our case study findings, it is necessary to perform long-term follow-up not only for brain AVMs but also for visceral vascular malformations in such patients, as well as perform HHT screening for families. Although such cases are rare, some features of HHT must be considered to accurately diagnose suspected HHT.


Assuntos
Fístula Arteriovenosa , Hemorragia Cerebral/cirurgia , Malformações Arteriovenosas Intracranianas , Telangiectasia Hemorrágica Hereditária , Adolescente , Angiografia Digital , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/cirurgia , Hemorragia Cerebral/etiologia , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Telangiectasia Hemorrágica Hereditária/etiologia , Telangiectasia Hemorrágica Hereditária/cirurgia
10.
Medicine (Baltimore) ; 98(52): e18418, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876715

RESUMO

RATIONALE: Brain arteriovenous malformation (BAVM)-associated varix is always asymptomatic, and no special treatment is needed. However, there is no consensus regarding how to address a varix that has led to clinical manifestation. PATIENT CONCERNS: An 11-year-old girl was admitted complaining of left hemiparesis for 4 days. She was previously healthy and denied any history of similar ictus. She was alert, and a physical examination performed upon admission was unremarkable except for the left hemiparesis. DIAGNOSES: Head magnetic resonance imaging (MRI) showed a linear and round flow void and perilesional edema in the region of the right basal ganglia, indicating a BAVM. Gadolinium-enhanced MRI showed peripheral enhancement of the round lesion. Computed tomography angiography (CTA) showed that the BAVM was fed by the ipsilateral posterior cerebral artery and anterior choroidal artery and drained into the vein of Galen. A large varix was also noted at the top of the BAVM and was consistent with the round flow void observed at the right basal ganglia on MRI. The Spetzler-Martin grading scale was grade IV INTERVENTIONS:: The patient experienced a TAE of the BAVM nidus with liquid embolic agent. OUTCOMES: A follow-up investigation showed regression of the varix, although there was still some residual BAVM. The patient experienced a favorable recovery. LESSONS: In the case of a BAVM-associated symptomatic varix, if surgical resection cannot readily be performed, initial TAE of the BAVM nidus can be attempted.


Assuntos
Malformações Arteriovenosas Intracranianas/terapia , Varizes/terapia , Criança , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/métodos , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Neuroimagem
11.
Undersea Hyperb Med ; 46(5): 713-717, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683372

RESUMO

A 16-year-old female patient with headache was admitted to our hospital. Radiological examination showed a Spetzler-Martin Grade III arteriovenous malformation (AVM) located at the left frontal lobe. Volume-staged stereotactic radiosurgery (SRS) treatment performed in two fractions at three-month intervals and post-procedural period were uneventful. Eight months later the patient was admitted to our hospital with headache, vomiting, right-sided facial palsy and right upper extremity paresthesia. Radiological examination demonstrated severe vasogenic edema in the left centrum semiovale and temporal region. Due to severe and steroid-resistant malign edema, hyperbaric oxygen (HBO2) therapy was performed as an alternative treatment option. Neurological symptoms resolved completely after HBO2. Radiological examination demonstrated serious improvement of brain edema and mass effect.


Assuntos
Edema Encefálico/terapia , Oxigenação Hiperbárica , Malformações Arteriovenosas Intracranianas/radioterapia , Radiocirurgia/efeitos adversos , Adolescente , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Radiocirurgia/métodos
12.
J Comput Assist Tomogr ; 43(6): 943-947, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738210

RESUMO

OBJECTIVE: Silent magnetic resonance angiography (MRA) was compared with time-of-flight (TOF)-MRA in imaging of arteriovenous malformations (AVMs) of the brain. METHODS: Thirty-five consecutive patients with AVMs of the brain were included. Quantitative analyses were performed by measuring both signal-to-noise ratio and contrast-to-noise ratio of the nidus. Qualitative analysis (scores 1-4) was performed by evaluating depictions of feeding arteries and draining veins independently by 2 reviewers. RESULTS: Both signal-to-noise ratio and contrast-to-noise ratio in TOF-MRA were significantly higher than those in silent MRA. For both feeders and drainers, scores were significantly higher in silent MRA than in TOF-MRA for both reviewers. Interrater agreement was higher in silent MRA than in TOF-MRA. CONCLUSIONS: Silent MRA visualized feeders and drainers in AVMs significantly better than did TOF-MRA. Interrater agreement was also better in silent MRA.


Assuntos
Angiografia Digital/métodos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Adolescente , Adulto , Feminino , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica , Razão Sinal-Ruído , Adulto Jovem
13.
J Stroke Cerebrovasc Dis ; 28(12): 104461, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31662240

RESUMO

While hemorrhage can occur because of developmental venous anomalies (DVAs), there is no established opinion concerning their association with pregnancy and childbirth. In the present report, we discuss the case of a now 39-year-old woman with DVA in whom pregnancy and childbirth were successful. When she was 28, she experienced disturbance of consciousness and paralysis on the left side of the body, and brain computed tomography revealed cerebral hemorrhage coupled with subarachnoid hemorrhage. Cerebral angiography revealed a DVA with an arteriovenous shunt, with superficial drainage surrounding the hematoma. No associated cavernous hemangiomas were observed, and the patient was diagnosed with DVA-induced hemorrhage and treated via conservative therapy. Later, at the ages of 32 and 35, she gave birth via Caesarean section under general anesthesia. At the age of 37, she experienced sudden headache and nausea, following which she was again diagnosed with DVA-induced hemorrhage. Fortunately, she experienced no exacerbation of symptoms such as paralysis. However, she currently has mild, residual paralysis on the left side of the body, and she regularly walks to the hospital using a cane for follow-up examinations.


Assuntos
Hemorragia Cerebral/etiologia , Cesárea , Malformações Arteriovenosas Intracranianas/complicações , Hemorragia Subaracnóidea/etiologia , Adulto , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Nascimento Vivo , Recidiva , Hemorragia Subaracnóidea/diagnóstico por imagem
15.
Neurochirurgie ; 65(6): 393-396, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31605684

RESUMO

BACKGROUND: Intracranial arteriovenous malformations (AVMs) are rare lesions that can be congenital or acquired in early childhood, with fatal outcome in approximately 30% of cases. De novo formation during adulthood without established predisposing vascular pathology or previous brain insult is even less frequent. CASE DESCRIPTION: We present a case of de novo brain AVM in an alcoholic Child-B cirrhosis setting. Thirty previously reported cases presented de novo AVM in patients of all ages that had another previous brain pathology or insult, such as AVM resection. Seventeen of those cases occurred in adult patients, with only 2 showing no significant predisposing factor. The present pathophysiological review covers and completes Mullan's hemodynamic "two-hit" model, associating probable thrombotic predisposition to AVM with brain insult triggering a later stage based on angiogenic stimuli. CONCLUSIONS: This case report and literature review renews previously discussed hemodynamic theories and contributes to a fuller understanding of the pathogenesis and progression of AVM. We postulate a causal link between hepatopathy and de novo AVM, which should be strengthened and interpreted based on recent genetic data and future prospective studies.


Assuntos
Malformações Arteriovenosas Intracranianas/etiologia , Cirrose Hepática/complicações , Progressão da Doença , Evolução Fatal , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Cirrose Hepática/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Exame Neurológico , Paresia/etiologia , Tomografia Computadorizada por Raios X
17.
No Shinkei Geka ; 47(9): 961-968, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31564657

RESUMO

Chronic encapsulated intracerebral hematoma(CEIH)with arteriovenous malformation(AVM)is rare. We report a case of CEIH shrinking after feeder embolization for AVM. A 60-year-old man experiencing headaches for 2 weeks was admitted to our hospital due to intracerebral hematoma detected by MRI. The hematoma was shown as a low-density mass lesion on CT scans. Angiography and enhanced MRI showed an AVM in the right temporal lobe associated with the CEIH. Mild disturbance of consciousness and headaches gradually worsened, as the CEIH grew. Before AVM resection, feeder embolization was performed. On the day after the embolization, symptoms improved and the CEIH shrunk in size. A week following the embolization, the AVM including the partial hematoma capsule was resected without neurological deficit. Previous literature showed similarities between CEIH and chronic subdural hematoma(CSDH)in clinical features and pathological findings of the capsule. This case indicated that feeder embolization might be a treatment option for CEIH with AVM, such as embolization of middle meningeal artery for intractable CSDH.


Assuntos
Hemorragia Cerebral , Embolização Terapêutica , Hematoma , Malformações Arteriovenosas Intracranianas , Hemorragia Cerebral/complicações , Hemorragia Cerebral/terapia , Hematoma/complicações , Hematoma/terapia , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
18.
World Neurosurg ; 132: e66-e75, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518746

RESUMO

BACKGROUND: The health care expenditure in Vietnam is equivalent to 1% of that in the United States. For most patients with brain arteriovenous malformations (AVM), surgery is the only available treatment modality. This study reports on the outcomes on AVM microsurgery in this resource-restricted environment. METHODS: This is a prospectively collected, retrospectively analyzed case series of consecutive patients who underwent surgical resection of AVM by a single surgeon in Vietnam. All surgeries were performed in a 3-year period in Hanoi. The primary endpoints were obliteration of the AVM and surgical morbidity (modified Rankin Scale [mRS] > 1). RESULTS: There were 86 patients and 62% presented with hemorrhage. Only 2 patients had preoperative embolization, and 47 patients (54%) had preoperative digital subtraction angiography. All patients underwent microsurgical resection of their AVM. Excluding the 4 patients who died, the AVM obliteration rate was 98%. The mean follow-up was 20.1 months. Before surgery, 36% of patients had at least some disability (mRS > 1). Postoperatively, this was reduced to 10% (McNemar P = 0.007). For the overall cohort, neurologic status was improved from initial encounter to final assessment (P = 0.001). Because of resource restrictions, some patients with hemorrhage experienced delays in treatment. There was no difference in outcome between patients who were admitted before or after 24 hours post ictus (P = 0.6). The days spent waiting for surgery did not correlate with final mRS in univariate regression (R2 = 0.01). CONCLUSIONS: Notwithstanding the limitation in health care resources in Vietnam, surgery for AVMs was successful in eliminating the malformation, with obliteration rates and morbidity comparable with international standards.


Assuntos
Revascularização Cerebral/métodos , Malformações Arteriovenosas Intracranianas/cirurgia , Adolescente , Adulto , Idoso , Angiografia Digital , Criança , Embolização Terapêutica , Determinação de Ponto Final , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Ruptura , Tempo para o Tratamento , Resultado do Tratamento , Vietnã , Adulto Jovem
19.
Cochrane Database Syst Rev ; 9: CD003436, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31503327

RESUMO

BACKGROUND: Brain arteriovenous malformations (AVMs) are the single most common cause of intracerebral haemorrhage in young adults. Brain AVMs also cause seizure(s) and focal neurological deficits (in the absence of haemorrhage, migraine or an epileptic seizure); approximately one-fifth are incidental discoveries. Various interventions are used in an attempt to eradicate brain AVMs: neurosurgical excision, stereotactic radiosurgery, endovascular embolization, and staged combinations of these interventions. This is an update of a Cochrane Review first published in 2006, and last updated in 2009. OBJECTIVES: To determine the effectiveness and safety of the different interventions, alone or in combination, for treating brain AVMs in adults compared against either each other, or conservative management, in randomized controlled trials (RCTs). SEARCH METHODS: The Cochrane Stroke Group Information Specialist searched the Cochrane Stroke Group Trials Register (last searched 7 January 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library, MEDLINE Ovid (1980 to 14 January 2019), and Embase OVID (1980 to 14 January 2019). We searched international registers of clinical trials, the contents pages of relevant journals, and bibliographies of relevant articles (November 2009). We also contacted manufacturers of interventional treatments for brain AVMs (March 2005). SELECTION CRITERIA: We sought RCTs of any intervention for brain AVMs (used alone or in combination), compared against each other or against conservative management, with relevant clinical outcome measures. DATA COLLECTION AND ANALYSIS: One author screened the results of the updated searches for potentially eligible RCTs for this updated review. Both authors independently read the potentially eligible RCTs in full and confirmed their inclusion according to the inclusion criteria. We resolved disagreement by discussion. We assessed the risk of bias in included studies and applied GRADE. MAIN RESULTS: We included one trial with 226 participants: A Randomized trial of Unruptured Brain Arteriovenous Malformations (ARUBA), comparing intervention versus conservative management for unruptured brain AVMs (that had never bled). The quality of evidence was moderate because we found just one trial that was at low risk of bias other than a high risk of performance bias due to participants and treating physicians not being blinded to allocated treatment. Data on functional outcome and death at a follow-up of 12 months were provided for 218 (96%) of the participants in ARUBA. In this randomized controlled trial (RCT), intervention compared to conservative management increased death or dependency (modified Rankin Scale score ≥ 2, risk ratio (RR) 2.53, 95% confidence interval (CI) 1.28 to 4.98; 1 trial, 226 participants; moderate-quality evidence) and the proportion of participants with symptomatic intracranial haemorrhage (RR 6.75, 95% CI 2.07 to 21.96; 1 trial, 226 participants; moderate-quality evidence), but there was no difference in the frequency of epileptic seizures (RR 1.14, 95% CI 0.63 to 2.06; 1 trial, 226 participants; moderate-quality evidence). Three RCTs are ongoing. AUTHORS' CONCLUSIONS: We found moderate-quality evidence from one RCT including adults with unruptured brain AVMs that conservative management was superior to intervention with respect to functional outcome and symptomatic intracranial haemorrhage over one year after randomization. More RCTs will help to confirm or refute these findings.


Assuntos
Malformações Arteriovenosas Intracranianas/terapia , Adulto , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/prevenção & controle , Tratamento Conservador , Embolização Terapêutica , Epilepsia/etiologia , Epilepsia/prevenção & controle , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Neurology ; 93(14): e1374-e1384, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31511351

RESUMO

OBJECTIVE: To discover the health-related quality of life (HRQOL) of patients with treated arteriovenous malformation (AVM), we used the self-applicable HRQOL instrument, the 15D, and analyzed the scores in both in the whole study population and specified cohorts. METHODS: The 15D questionnaires were mailed to adult patients with AVM alive in 2016 (n = 432) in our database. Patients with completely eradicated AVM (n = 262) were included in a subsequent analysis. The results were compared with those of the general population standardized for age and sex. Subgroup analyses were conducted for epilepsy, number of bleeding episodes, location of the lesion, modified Rankin Scale score, and Spetzler-Ponce classification (SPC) using independent-samples t test or analysis of covariance. Tobit regression was used to explain the variance in the 15D score. RESULTS: Patients had impaired HRQOL compared to the reference population (p < 0.0001). Deep location, multiple bleeding episodes, and refractory epilepsy were associated with impaired HRQOL. Patients in SPC A and B had similar posttreatment 15D scores, whereas those in class C had an impaired HRQOL. Significant explanatory variables in the regression model were age, sex, number of bleeding episodes, refractory epilepsy, and SPC. CONCLUSIONS: With careful patient selection, patients in SPC B can reach as favorable HRQOL as those in SPC A provided the operation is successful. Multiple bleeding episodes should be prevented with effective treatment aiming at complete AVM obliteration. The postoperative treatment of patients with AVM should focus on preventing depressive symptoms, anxiety, and epileptic seizures. We encourage other research groups to use HRQOL instruments to fully understand the consequences of neurologic and neurosurgical diseases on patients' HRQOL.


Assuntos
Fístula Arteriovenosa/metabolismo , Fístula Arteriovenosa/psicologia , Malformações Arteriovenosas Intracranianas/metabolismo , Malformações Arteriovenosas Intracranianas/psicologia , Qualidade de Vida/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Espectroscopia de Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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