Interventions for treating brain arteriovenous malformations in adults
- 10 September 2019
- journal article
- review article
- Published by Wiley in Emergencias
- Vol. 2019 (9), CD003436
- https://doi.org/10.1002/14651858.cd003436.pub4
Abstract
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.Keywords
This publication has 37 references indexed in Scilit:
- Treatment guidelines for cerebral arteriovenous malformation microsurgeryBritish Journal of Neurosurgery, 2009
- Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort studyThe Lancet Neurology, 2008
- Feasibility of Minocycline and Doxycycline Use as Potential Vasculostatic Therapy for Brain Vascular Malformations: Pilot Study of Adverse Events and ToleranceCerebrovascular Diseases, 2008
- Interventions for Treating Brain Arteriovenous Malformations in AdultsStroke, 2006
- Interventions for treating brain arteriovenous malformations in adultsPublished by Wiley ,2006
- Long-Term Hemorrhage Risk in Children Versus Adults With Brain Arteriovenous MalformationsStroke, 2005
- Prospective, Population-Based Detection of Intracranial Vascular Malformations in AdultsStroke, 2003
- The New York Islands AVM StudyStroke, 2003
- Recommendations for the Management of Intracranial Arteriovenous MalformationsStroke, 2001
- Reporting Terminology for Brain Arteriovenous Malformation Clinical and Radiographic Features for Use in Clinical TrialsStroke, 2001