Delayed Hemorrhage Following Treatment of Brain Arteriovenous Malformations (AVMs).

Delayed Hemorrhage Following Treatment of Brain Arteriovenous Malformations (AVMs).

World Neurosurg. 2015 Dec 15;

Authors: Yang W, Hung A, Caplan JM, Braileanu M, Wang JY, Colby GP, Coon AL, Tamargo RJ, Huang J

Abstract
OBJECT: The risk of delayed hemorrhage, occurring greater than 2 years following treatment in brain arteriovenous malformations (AVM) is rarely reported. In this study, we compare the risk of delayed hemorrhage across different treatment modalities.
METHODS: We performed a retrospective chart review of treated patients with a single intracranial AVM seen at our institution from 1990-2013. Delayed hemorrhage was defined as hemorrhage occurring at least 2 years after last treatment. Survival analysis was used to assess risk of delayed hemorrhage by treatment modalities.
RESULTS: Our study included 420 patients. Spetzler-Martin grades were: I(12.6%), II(36.2%), III(32.6%), IV(15.0%), V(3.6%). Average follow-up time is 5.1 years. Twenty-two patients (5.2%) were found to have 28 delayed hemorrhages. Average interval between last treatment and delayed hemorrhage is 7.6 years, with the longest being 24.2 years. Proportions of delayed hemorrhages by treatment modalities were: surgery ± embolization (group I, 9.1%), radiosurgery ± embolization (group II, 63.6%), embolization only (group III, 22.7%) and surgery + radiosurgery ± embolization (group IV, 4.5%). Annualized hemorrhage risk after 2 years for each treatment group was: group I(0.4%), group II(1.2%), group III(3.7%), group IV(1.7%). Survival analysis demonstrated lowest risk of delayed hemorrhage for group 1 (p < 0.01).
CONCLUSIONS: This study is the first to compare the risk of delayed hemorrhage across different treatment modalities. Surgical resection is associated with the lowest risk for delayed hemorrhage compared to other treatment modalities. Patients with partially embolized AVMs should seek timely definitive treatment to reduce the risk of delayed hemorrhage.

PMID: 26704216 [PubMed - as supplied by publisher]

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