Clinical outcome following cerebral AVM hemorrhage
Background A significant difference exists between the published results reporting the clinical outcome following brain arteriovenous malformation (AVM) ruptures. Information about the outcome following hemorrhage in an AVM population treated with radiosurgery could provide additional information to...
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| Veröffentlicht in: | Acta neurochirurgica 2020-07, Vol.162 (7), p.1759-1766 |
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| container_title | Acta neurochirurgica |
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| creator | Karlsson, Bengt Jokura, Hidefumi Yang, Huai-Che Yamamoto, Masaaki Martinez, Roberto Kawagishi, Jun Guo, Wan-Yuo Beute, Guus Chung, Wen-Yuh Söderman, Michael Yeo, Tseng Tsai |
| description | Background
A significant difference exists between the published results reporting the clinical outcome following brain arteriovenous malformation (AVM) ruptures. Information about the outcome following hemorrhage in an AVM population treated with radiosurgery could provide additional information to assess the risk of mortality and morbidity following an AVM hemorrhage.
Methods
Clinical outcome was studied in 383 patients, the largest patient population yet studied, who suffered from a symptomatic hemorrhage after Gamma Knife® surgery (GKS) but before confirmed AVM obliteration. The impact of different patient, AVM, and treatment parameters on the clinical outcome was analyzed. The aim was to generate outcome predictions by comparing our data to and combining them with earlier published results.
Results
No relation was found between clinical outcome and treatment parameters, indicating that the results are applicable also on untreated AVMs. Twenty-one percent of the patients died, 45% developed or experienced worsening of neurological sequelae, and 35% recovered completely after the hemorrhage. Old age was a predictor of poor outcome. Sex, AVM location, AVM volume, and history of prior hemorrhage did not influence the outcome. The mortality rate was comparable to earlier published prospective data, but higher than that found in retrospective studies.
Conclusions
The mortality rates in earlier published retrospective series as well as in studies focusing on clinical outcome following AVM hemorrhage significantly underestimate the risk for a mortal outcome following an AVM hemorrhage. Based on our findings, an AVM rupture has around 20% likelihood to result in mortality, 45% likelihood to result in a minor or major deficit, and 35% likelihood of complete recovery. The findings are probably applicable also for AVM ruptures in general. The cumulative mortality and morbidity rates 25 years after diagnosis were estimated to be around 40% in a patient with a patent AVM. |
| doi_str_mv | 10.1007/s00701-020-04380-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_471431</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2413230836</sourcerecordid><originalsourceid>FETCH-LOGICAL-c413t-e632f1fcb409755dc13b5649791a2e8dbff2b7d404b3e3b90997adfbbfe9efd83</originalsourceid><addsrcrecordid>eNp9UMtOwzAQtBCIlsIPcECROBvWj7yOVcVLAnEBrlacrNuUpC52o4p-PYaEcuOyu96ZHY-GkHMGVwwgvfahAKPAgYIUGdDdARlDLjkNBQ7DDAFOeJKNyIn3y_DiqRTHZCS4yOJEJGPCZ029qsuiiWy3KW2LkbFNY7f1ah6V6FC7AE3fnqIFtta5RTHHU3Jkisbj2dAn5PX25mV2Tx-f7x5m00daSiY2FBPBDTOllpCncVyVTOg4kXmas4JjVmljuE4rCVILFDqHPE-LymhtMEdTZWJCaK_rt7jutFq7ui3cp7JFrYbVe5hQyZRJwQL_suevnf3o0G_U0nZuFSwqHhxxAZlIAov3rNJZ7x2avS4D9R2r6mNVIVb1E6vahaOLQbrTLVb7k98cA0EMXgO0mqP7-_sf2S_m8YM7</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2413230836</pqid></control><display><type>article</type><title>Clinical outcome following cerebral AVM hemorrhage</title><source>MEDLINE</source><source>Springer Journals</source><creator>Karlsson, Bengt ; Jokura, Hidefumi ; Yang, Huai-Che ; Yamamoto, Masaaki ; Martinez, Roberto ; Kawagishi, Jun ; Guo, Wan-Yuo ; Beute, Guus ; Chung, Wen-Yuh ; Söderman, Michael ; Yeo, Tseng Tsai</creator><creatorcontrib>Karlsson, Bengt ; Jokura, Hidefumi ; Yang, Huai-Che ; Yamamoto, Masaaki ; Martinez, Roberto ; Kawagishi, Jun ; Guo, Wan-Yuo ; Beute, Guus ; Chung, Wen-Yuh ; Söderman, Michael ; Yeo, Tseng Tsai</creatorcontrib><description>Background
A significant difference exists between the published results reporting the clinical outcome following brain arteriovenous malformation (AVM) ruptures. Information about the outcome following hemorrhage in an AVM population treated with radiosurgery could provide additional information to assess the risk of mortality and morbidity following an AVM hemorrhage.
Methods
Clinical outcome was studied in 383 patients, the largest patient population yet studied, who suffered from a symptomatic hemorrhage after Gamma Knife® surgery (GKS) but before confirmed AVM obliteration. The impact of different patient, AVM, and treatment parameters on the clinical outcome was analyzed. The aim was to generate outcome predictions by comparing our data to and combining them with earlier published results.
Results
No relation was found between clinical outcome and treatment parameters, indicating that the results are applicable also on untreated AVMs. Twenty-one percent of the patients died, 45% developed or experienced worsening of neurological sequelae, and 35% recovered completely after the hemorrhage. Old age was a predictor of poor outcome. Sex, AVM location, AVM volume, and history of prior hemorrhage did not influence the outcome. The mortality rate was comparable to earlier published prospective data, but higher than that found in retrospective studies.
Conclusions
The mortality rates in earlier published retrospective series as well as in studies focusing on clinical outcome following AVM hemorrhage significantly underestimate the risk for a mortal outcome following an AVM hemorrhage. Based on our findings, an AVM rupture has around 20% likelihood to result in mortality, 45% likelihood to result in a minor or major deficit, and 35% likelihood of complete recovery. The findings are probably applicable also for AVM ruptures in general. The cumulative mortality and morbidity rates 25 years after diagnosis were estimated to be around 40% in a patient with a patent AVM.</description><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-020-04380-z</identifier><identifier>PMID: 32385636</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Adolescent ; Adult ; Child ; Clinical outcomes ; Female ; Hemorrhage ; Hemorrhage - epidemiology ; Hemorrhage - etiology ; Hemorrhage - mortality ; Humans ; Interventional Radiology ; Intracranial Arteriovenous Malformations - surgery ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Minimally Invasive Surgery ; Morbidity ; Mortality ; Neurological complications ; Neurology ; Neuroradiology ; Neurosurgery ; Original Article - Vascular Neurosurgery - Arteriovenous malformation ; Patients ; Population studies ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - mortality ; Radiosurgery ; Radiosurgery - adverse effects ; Radiosurgery - methods ; Surgery ; Surgical Orthopedics ; Vascular Neurosurgery – Arteriovenous malformation</subject><ispartof>Acta neurochirurgica, 2020-07, Vol.162 (7), p.1759-1766</ispartof><rights>Springer-Verlag GmbH Austria, part of Springer Nature 2020</rights><rights>Springer-Verlag GmbH Austria, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c413t-e632f1fcb409755dc13b5649791a2e8dbff2b7d404b3e3b90997adfbbfe9efd83</citedby><cites>FETCH-LOGICAL-c413t-e632f1fcb409755dc13b5649791a2e8dbff2b7d404b3e3b90997adfbbfe9efd83</cites><orcidid>0000-0002-2937-3041</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00701-020-04380-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00701-020-04380-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32385636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:143648305$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Karlsson, Bengt</creatorcontrib><creatorcontrib>Jokura, Hidefumi</creatorcontrib><creatorcontrib>Yang, Huai-Che</creatorcontrib><creatorcontrib>Yamamoto, Masaaki</creatorcontrib><creatorcontrib>Martinez, Roberto</creatorcontrib><creatorcontrib>Kawagishi, Jun</creatorcontrib><creatorcontrib>Guo, Wan-Yuo</creatorcontrib><creatorcontrib>Beute, Guus</creatorcontrib><creatorcontrib>Chung, Wen-Yuh</creatorcontrib><creatorcontrib>Söderman, Michael</creatorcontrib><creatorcontrib>Yeo, Tseng Tsai</creatorcontrib><title>Clinical outcome following cerebral AVM hemorrhage</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Background
A significant difference exists between the published results reporting the clinical outcome following brain arteriovenous malformation (AVM) ruptures. Information about the outcome following hemorrhage in an AVM population treated with radiosurgery could provide additional information to assess the risk of mortality and morbidity following an AVM hemorrhage.
Methods
Clinical outcome was studied in 383 patients, the largest patient population yet studied, who suffered from a symptomatic hemorrhage after Gamma Knife® surgery (GKS) but before confirmed AVM obliteration. The impact of different patient, AVM, and treatment parameters on the clinical outcome was analyzed. The aim was to generate outcome predictions by comparing our data to and combining them with earlier published results.
Results
No relation was found between clinical outcome and treatment parameters, indicating that the results are applicable also on untreated AVMs. Twenty-one percent of the patients died, 45% developed or experienced worsening of neurological sequelae, and 35% recovered completely after the hemorrhage. Old age was a predictor of poor outcome. Sex, AVM location, AVM volume, and history of prior hemorrhage did not influence the outcome. The mortality rate was comparable to earlier published prospective data, but higher than that found in retrospective studies.
Conclusions
The mortality rates in earlier published retrospective series as well as in studies focusing on clinical outcome following AVM hemorrhage significantly underestimate the risk for a mortal outcome following an AVM hemorrhage. Based on our findings, an AVM rupture has around 20% likelihood to result in mortality, 45% likelihood to result in a minor or major deficit, and 35% likelihood of complete recovery. The findings are probably applicable also for AVM ruptures in general. The cumulative mortality and morbidity rates 25 years after diagnosis were estimated to be around 40% in a patient with a patent AVM.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Child</subject><subject>Clinical outcomes</subject><subject>Female</subject><subject>Hemorrhage</subject><subject>Hemorrhage - epidemiology</subject><subject>Hemorrhage - etiology</subject><subject>Hemorrhage - mortality</subject><subject>Humans</subject><subject>Interventional Radiology</subject><subject>Intracranial Arteriovenous Malformations - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgery</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Neurological complications</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Original Article - Vascular Neurosurgery - Arteriovenous malformation</subject><subject>Patients</subject><subject>Population studies</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - mortality</subject><subject>Radiosurgery</subject><subject>Radiosurgery - adverse effects</subject><subject>Radiosurgery - methods</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Vascular Neurosurgery – Arteriovenous malformation</subject><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9UMtOwzAQtBCIlsIPcECROBvWj7yOVcVLAnEBrlacrNuUpC52o4p-PYaEcuOyu96ZHY-GkHMGVwwgvfahAKPAgYIUGdDdARlDLjkNBQ7DDAFOeJKNyIn3y_DiqRTHZCS4yOJEJGPCZ029qsuiiWy3KW2LkbFNY7f1ah6V6FC7AE3fnqIFtta5RTHHU3Jkisbj2dAn5PX25mV2Tx-f7x5m00daSiY2FBPBDTOllpCncVyVTOg4kXmas4JjVmljuE4rCVILFDqHPE-LymhtMEdTZWJCaK_rt7jutFq7ui3cp7JFrYbVe5hQyZRJwQL_suevnf3o0G_U0nZuFSwqHhxxAZlIAov3rNJZ7x2avS4D9R2r6mNVIVb1E6vahaOLQbrTLVb7k98cA0EMXgO0mqP7-_sf2S_m8YM7</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Karlsson, Bengt</creator><creator>Jokura, Hidefumi</creator><creator>Yang, Huai-Che</creator><creator>Yamamoto, Masaaki</creator><creator>Martinez, Roberto</creator><creator>Kawagishi, Jun</creator><creator>Guo, Wan-Yuo</creator><creator>Beute, Guus</creator><creator>Chung, Wen-Yuh</creator><creator>Söderman, Michael</creator><creator>Yeo, Tseng Tsai</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>ADTPV</scope><scope>AOWAS</scope><orcidid>https://orcid.org/0000-0002-2937-3041</orcidid></search><sort><creationdate>20200701</creationdate><title>Clinical outcome following cerebral AVM hemorrhage</title><author>Karlsson, Bengt ; Jokura, Hidefumi ; Yang, Huai-Che ; Yamamoto, Masaaki ; Martinez, Roberto ; Kawagishi, Jun ; Guo, Wan-Yuo ; Beute, Guus ; Chung, Wen-Yuh ; Söderman, Michael ; Yeo, Tseng Tsai</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c413t-e632f1fcb409755dc13b5649791a2e8dbff2b7d404b3e3b90997adfbbfe9efd83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Child</topic><topic>Clinical outcomes</topic><topic>Female</topic><topic>Hemorrhage</topic><topic>Hemorrhage - epidemiology</topic><topic>Hemorrhage - etiology</topic><topic>Hemorrhage - mortality</topic><topic>Humans</topic><topic>Interventional Radiology</topic><topic>Intracranial Arteriovenous Malformations - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgery</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Neurological complications</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Original Article - Vascular Neurosurgery - Arteriovenous malformation</topic><topic>Patients</topic><topic>Population studies</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - mortality</topic><topic>Radiosurgery</topic><topic>Radiosurgery - adverse effects</topic><topic>Radiosurgery - methods</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Vascular Neurosurgery – Arteriovenous malformation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karlsson, Bengt</creatorcontrib><creatorcontrib>Jokura, Hidefumi</creatorcontrib><creatorcontrib>Yang, Huai-Che</creatorcontrib><creatorcontrib>Yamamoto, Masaaki</creatorcontrib><creatorcontrib>Martinez, Roberto</creatorcontrib><creatorcontrib>Kawagishi, Jun</creatorcontrib><creatorcontrib>Guo, Wan-Yuo</creatorcontrib><creatorcontrib>Beute, Guus</creatorcontrib><creatorcontrib>Chung, Wen-Yuh</creatorcontrib><creatorcontrib>Söderman, Michael</creatorcontrib><creatorcontrib>Yeo, Tseng Tsai</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>SwePub</collection><collection>SwePub Articles</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karlsson, Bengt</au><au>Jokura, Hidefumi</au><au>Yang, Huai-Che</au><au>Yamamoto, Masaaki</au><au>Martinez, Roberto</au><au>Kawagishi, Jun</au><au>Guo, Wan-Yuo</au><au>Beute, Guus</au><au>Chung, Wen-Yuh</au><au>Söderman, Michael</au><au>Yeo, Tseng Tsai</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcome following cerebral AVM hemorrhage</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2020-07-01</date><risdate>2020</risdate><volume>162</volume><issue>7</issue><spage>1759</spage><epage>1766</epage><pages>1759-1766</pages><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>Background
A significant difference exists between the published results reporting the clinical outcome following brain arteriovenous malformation (AVM) ruptures. Information about the outcome following hemorrhage in an AVM population treated with radiosurgery could provide additional information to assess the risk of mortality and morbidity following an AVM hemorrhage.
Methods
Clinical outcome was studied in 383 patients, the largest patient population yet studied, who suffered from a symptomatic hemorrhage after Gamma Knife® surgery (GKS) but before confirmed AVM obliteration. The impact of different patient, AVM, and treatment parameters on the clinical outcome was analyzed. The aim was to generate outcome predictions by comparing our data to and combining them with earlier published results.
Results
No relation was found between clinical outcome and treatment parameters, indicating that the results are applicable also on untreated AVMs. Twenty-one percent of the patients died, 45% developed or experienced worsening of neurological sequelae, and 35% recovered completely after the hemorrhage. Old age was a predictor of poor outcome. Sex, AVM location, AVM volume, and history of prior hemorrhage did not influence the outcome. The mortality rate was comparable to earlier published prospective data, but higher than that found in retrospective studies.
Conclusions
The mortality rates in earlier published retrospective series as well as in studies focusing on clinical outcome following AVM hemorrhage significantly underestimate the risk for a mortal outcome following an AVM hemorrhage. Based on our findings, an AVM rupture has around 20% likelihood to result in mortality, 45% likelihood to result in a minor or major deficit, and 35% likelihood of complete recovery. The findings are probably applicable also for AVM ruptures in general. The cumulative mortality and morbidity rates 25 years after diagnosis were estimated to be around 40% in a patient with a patent AVM.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>32385636</pmid><doi>10.1007/s00701-020-04380-z</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2937-3041</orcidid></addata></record> |
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| source | MEDLINE; Springer Journals |
| subjects | Adolescent Adult Child Clinical outcomes Female Hemorrhage Hemorrhage - epidemiology Hemorrhage - etiology Hemorrhage - mortality Humans Interventional Radiology Intracranial Arteriovenous Malformations - surgery Male Medicine Medicine & Public Health Middle Aged Minimally Invasive Surgery Morbidity Mortality Neurological complications Neurology Neuroradiology Neurosurgery Original Article - Vascular Neurosurgery - Arteriovenous malformation Patients Population studies Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - mortality Radiosurgery Radiosurgery - adverse effects Radiosurgery - methods Surgery Surgical Orthopedics Vascular Neurosurgery – Arteriovenous malformation |
| title | Clinical outcome following cerebral AVM hemorrhage |
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