Article
Risk of rebleeding in patients suffering from ruptured brain arteriovenous malformation undergoing delayed treatment – single-centre series and systematic review of the literature
Das Nachblutungsrisiko bei zeitlich versetzter Versorgung gebluteter arteriovenöser Malformationen
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Authors
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Patrick Schuss
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Alexis Hadjiathanasiou
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Valeri Borger
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Inja Ilic
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Ági Güresir
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Hartmut Vatter
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Erdem Güresir
- Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Immediate surgical treatment is not always required in patients presenting with ruptured brain arteriovenous malformation (bAVM). However, the optimal timing of ruptured bAVM is still controversial discussed. The present study aims to determine safety of delayed bAVM management in clinically stable patients by identifying the rate of rebleeding in patients with ruptured bAVMs.
Methods: Patients presenting from 2000 to 2017 with ruptured bAVM who were scheduled for bAVM-treatment at least 4 weeks after initial hemorrhage were include in the present study. If delayed treatment was feasible, patients were monitored until they were stable enough for transfer to rehabilitation. After neurological rehabilitation of the patient and decrease of hemorrhage-induced brain swelling, delayed treatment for the ruptured bAVM was carried out. Primary outcome of the present series was defined as treatment failure due to rehemorrhage caused by the ruptured bAVM in patients previously labeled eligible for delayed bAVM treatment. Exclusion criteria were ruptured bAVM that required immediate or subacute bAVM resection due to large hematoma, acute neurological deterioration or flow-associated aneurysm. Additionally, we performed a systematic review of the contemporary peer-reviewed literature concerning treatment strategy in patients with ruptured bAVM.
Results: From 2000 to 2017, 55 patients suffering from ruptured AVM were considered eligible for delayed bAVM treatment at our institution. No patient suffered from early rebleeding before definitive bAVM treatment in this selected group. Patient data of both the present series and the systematic literature review were pooled resulting in a total of 168 patients suffering from ruptured bAVM who underwent delayed bAVM treatment. In the pooled analysis with 168 patients with delayed bAVM treatment, 3 patients (2%) suffered from rehemorrhage during the recovery period after initial bAVM rupture.
Conclusion: The present series and systematic review revealed a rehemorrhage rate of 2% in patients suffering from ruptured bAVM who underwent delayed treatment. Therefore, delayed treatment of patients with ruptured bAVM seems safe after application of rigorous treatment algorithms in order to sort out patients with higher risk for rehemorrhage.
