Patterns of brain arteriovenous malformation treatment

Janneke van Beijnum, Jo J Bhattacharya, Carl Edward Counsell, Vakis Papanastassiou, Vaughn Ritchie, Richard C Roberts, Robin J Sellar, Charles Warlow, Rustam Al-Shahi Salman, Scottish Intracranial Vascular Malformation Study Collaborators

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background and Purpose-The extent of variation in the interventional treatment of brain arteriovenous malformations (AVMs) is unknown, so we explored patterns of treatment at 4 neuroscience centers in one European country.

Methods-We included every participant with an AVM in a prospective, population-based cohort study of adults aged >= 16 years residing in Scotland at the time of AVM diagnosis in 1999 to 2003.

Results-Only 11 (5%) of the 229 adults were not managed at a neuroscience center. Adults who received interventional treatment were younger (median, 43 versus 54 years), more likely to have presented with hemorrhage (OR, 2.8; 95% CI, 1.6 to 4.9), and had smaller AVMs (median nidus diameter, 2 cm versus 3 cm; P=0.003) than those who did not. Adults seen at the 4 centers only differed in AVM Spetzler-Martin grade (P=0.04). The 4 centers did not differ in the proportion of adults with AVMs who received interventional treatment (P=0.16), but they differed in the Spetzler-Martin grade of the AVMs they treated (Grades III to IV, P=0.01) and the interventional treatments used (P=0.004). The 2 largest centers differed from each other in the likelihood of surgical resection (OR, 0.2; 95% CI, 0.1 to 0.6) and stereotactic radiosurgery (OR, 2.8; 95% CI, 1.3 to 6.1), and the choice of modality varied within some Spetzler-Martin grades.

Conclusions-Patient characteristics and patterns of AVM interventional treatment differ between neuroscience centers in the same population necessitating careful consideration of these factors when comparing one hospital's outcome with another. (Stroke. 2008;39:3216-3221.)
Original languageEnglish
Pages (from-to)3216-3221
Number of pages6
JournalStroke
Volume39
Issue number12
Early online date11 Sep 2008
DOIs
Publication statusPublished - Dec 2008

Fingerprint

Arteriovenous Malformations
Brain
Neurosciences
Therapeutics
Radiosurgery
Scotland
Population
Cohort Studies
Stroke
Hemorrhage

Keywords

  • adolescent
  • adult
  • aged
  • aged, 80 and over
  • brain damage, chronic
  • cerebral hemorrhage
  • craniotomy
  • female
  • hospitals, special
  • humans
  • intracranial arteriovenous malformations
  • male
  • middle aged
  • neurosciences
  • prospective studies
  • radiosurgery
  • registries
  • Scotland
  • severity of illness index
  • treatment outcome
  • aneurysm
  • arteriovenous malformations
  • AVM
  • cerebral aneurysm
  • hematoma
  • other stroke treatment – surgical
  • subarachnoid hemorrhage
  • intracranial vascular malformation
  • endosvascular treatment
  • natural-history
  • hemorrhage
  • management
  • pressure
  • cohort
  • adults
  • SIVMS

Cite this

van Beijnum, J., Bhattacharya, J. J., Counsell, C. E., Papanastassiou, V., Ritchie, V., Roberts, R. C., ... Scottish Intracranial Vascular Malformation Study Collaborators (2008). Patterns of brain arteriovenous malformation treatment. Stroke, 39(12), 3216-3221. https://doi.org/10.1161/STROKEAHA.108.523662

Patterns of brain arteriovenous malformation treatment. / van Beijnum, Janneke; Bhattacharya, Jo J; Counsell, Carl Edward; Papanastassiou, Vakis; Ritchie, Vaughn; Roberts, Richard C; Sellar, Robin J; Warlow, Charles; Al-Shahi Salman, Rustam; Scottish Intracranial Vascular Malformation Study Collaborators.

In: Stroke, Vol. 39, No. 12, 12.2008, p. 3216-3221.

Research output: Contribution to journalArticle

van Beijnum, J, Bhattacharya, JJ, Counsell, CE, Papanastassiou, V, Ritchie, V, Roberts, RC, Sellar, RJ, Warlow, C, Al-Shahi Salman, R & Scottish Intracranial Vascular Malformation Study Collaborators 2008, 'Patterns of brain arteriovenous malformation treatment', Stroke, vol. 39, no. 12, pp. 3216-3221. https://doi.org/10.1161/STROKEAHA.108.523662
van Beijnum J, Bhattacharya JJ, Counsell CE, Papanastassiou V, Ritchie V, Roberts RC et al. Patterns of brain arteriovenous malformation treatment. Stroke. 2008 Dec;39(12):3216-3221. https://doi.org/10.1161/STROKEAHA.108.523662
van Beijnum, Janneke ; Bhattacharya, Jo J ; Counsell, Carl Edward ; Papanastassiou, Vakis ; Ritchie, Vaughn ; Roberts, Richard C ; Sellar, Robin J ; Warlow, Charles ; Al-Shahi Salman, Rustam ; Scottish Intracranial Vascular Malformation Study Collaborators. / Patterns of brain arteriovenous malformation treatment. In: Stroke. 2008 ; Vol. 39, No. 12. pp. 3216-3221.
@article{7b5ce4874c1d4f92a6c17b74425c20c0,
title = "Patterns of brain arteriovenous malformation treatment",
abstract = "Background and Purpose-The extent of variation in the interventional treatment of brain arteriovenous malformations (AVMs) is unknown, so we explored patterns of treatment at 4 neuroscience centers in one European country.Methods-We included every participant with an AVM in a prospective, population-based cohort study of adults aged >= 16 years residing in Scotland at the time of AVM diagnosis in 1999 to 2003.Results-Only 11 (5{\%}) of the 229 adults were not managed at a neuroscience center. Adults who received interventional treatment were younger (median, 43 versus 54 years), more likely to have presented with hemorrhage (OR, 2.8; 95{\%} CI, 1.6 to 4.9), and had smaller AVMs (median nidus diameter, 2 cm versus 3 cm; P=0.003) than those who did not. Adults seen at the 4 centers only differed in AVM Spetzler-Martin grade (P=0.04). The 4 centers did not differ in the proportion of adults with AVMs who received interventional treatment (P=0.16), but they differed in the Spetzler-Martin grade of the AVMs they treated (Grades III to IV, P=0.01) and the interventional treatments used (P=0.004). The 2 largest centers differed from each other in the likelihood of surgical resection (OR, 0.2; 95{\%} CI, 0.1 to 0.6) and stereotactic radiosurgery (OR, 2.8; 95{\%} CI, 1.3 to 6.1), and the choice of modality varied within some Spetzler-Martin grades.Conclusions-Patient characteristics and patterns of AVM interventional treatment differ between neuroscience centers in the same population necessitating careful consideration of these factors when comparing one hospital's outcome with another. (Stroke. 2008;39:3216-3221.)",
keywords = "adolescent, adult, aged, aged, 80 and over, brain damage, chronic, cerebral hemorrhage, craniotomy, female, hospitals, special, humans, intracranial arteriovenous malformations, male, middle aged, neurosciences , prospective studies, radiosurgery, registries, Scotland, severity of illness index, treatment outcome, aneurysm , arteriovenous malformations , AVM , cerebral aneurysm , hematoma , other stroke treatment – surgical , subarachnoid hemorrhage, intracranial vascular malformation, endosvascular treatment, natural-history, hemorrhage, management, pressure, cohort, adults, SIVMS",
author = "{van Beijnum}, Janneke and Bhattacharya, {Jo J} and Counsell, {Carl Edward} and Vakis Papanastassiou and Vaughn Ritchie and Roberts, {Richard C} and Sellar, {Robin J} and Charles Warlow and {Al-Shahi Salman}, Rustam and {Scottish Intracranial Vascular Malformation Study Collaborators}",
year = "2008",
month = "12",
doi = "10.1161/STROKEAHA.108.523662",
language = "English",
volume = "39",
pages = "3216--3221",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Patterns of brain arteriovenous malformation treatment

AU - van Beijnum, Janneke

AU - Bhattacharya, Jo J

AU - Counsell, Carl Edward

AU - Papanastassiou, Vakis

AU - Ritchie, Vaughn

AU - Roberts, Richard C

AU - Sellar, Robin J

AU - Warlow, Charles

AU - Al-Shahi Salman, Rustam

AU - Scottish Intracranial Vascular Malformation Study Collaborators

PY - 2008/12

Y1 - 2008/12

N2 - Background and Purpose-The extent of variation in the interventional treatment of brain arteriovenous malformations (AVMs) is unknown, so we explored patterns of treatment at 4 neuroscience centers in one European country.Methods-We included every participant with an AVM in a prospective, population-based cohort study of adults aged >= 16 years residing in Scotland at the time of AVM diagnosis in 1999 to 2003.Results-Only 11 (5%) of the 229 adults were not managed at a neuroscience center. Adults who received interventional treatment were younger (median, 43 versus 54 years), more likely to have presented with hemorrhage (OR, 2.8; 95% CI, 1.6 to 4.9), and had smaller AVMs (median nidus diameter, 2 cm versus 3 cm; P=0.003) than those who did not. Adults seen at the 4 centers only differed in AVM Spetzler-Martin grade (P=0.04). The 4 centers did not differ in the proportion of adults with AVMs who received interventional treatment (P=0.16), but they differed in the Spetzler-Martin grade of the AVMs they treated (Grades III to IV, P=0.01) and the interventional treatments used (P=0.004). The 2 largest centers differed from each other in the likelihood of surgical resection (OR, 0.2; 95% CI, 0.1 to 0.6) and stereotactic radiosurgery (OR, 2.8; 95% CI, 1.3 to 6.1), and the choice of modality varied within some Spetzler-Martin grades.Conclusions-Patient characteristics and patterns of AVM interventional treatment differ between neuroscience centers in the same population necessitating careful consideration of these factors when comparing one hospital's outcome with another. (Stroke. 2008;39:3216-3221.)

AB - Background and Purpose-The extent of variation in the interventional treatment of brain arteriovenous malformations (AVMs) is unknown, so we explored patterns of treatment at 4 neuroscience centers in one European country.Methods-We included every participant with an AVM in a prospective, population-based cohort study of adults aged >= 16 years residing in Scotland at the time of AVM diagnosis in 1999 to 2003.Results-Only 11 (5%) of the 229 adults were not managed at a neuroscience center. Adults who received interventional treatment were younger (median, 43 versus 54 years), more likely to have presented with hemorrhage (OR, 2.8; 95% CI, 1.6 to 4.9), and had smaller AVMs (median nidus diameter, 2 cm versus 3 cm; P=0.003) than those who did not. Adults seen at the 4 centers only differed in AVM Spetzler-Martin grade (P=0.04). The 4 centers did not differ in the proportion of adults with AVMs who received interventional treatment (P=0.16), but they differed in the Spetzler-Martin grade of the AVMs they treated (Grades III to IV, P=0.01) and the interventional treatments used (P=0.004). The 2 largest centers differed from each other in the likelihood of surgical resection (OR, 0.2; 95% CI, 0.1 to 0.6) and stereotactic radiosurgery (OR, 2.8; 95% CI, 1.3 to 6.1), and the choice of modality varied within some Spetzler-Martin grades.Conclusions-Patient characteristics and patterns of AVM interventional treatment differ between neuroscience centers in the same population necessitating careful consideration of these factors when comparing one hospital's outcome with another. (Stroke. 2008;39:3216-3221.)

KW - adolescent

KW - adult

KW - aged

KW - aged, 80 and over

KW - brain damage, chronic

KW - cerebral hemorrhage

KW - craniotomy

KW - female

KW - hospitals, special

KW - humans

KW - intracranial arteriovenous malformations

KW - male

KW - middle aged

KW - neurosciences

KW - prospective studies

KW - radiosurgery

KW - registries

KW - Scotland

KW - severity of illness index

KW - treatment outcome

KW - aneurysm

KW - arteriovenous malformations

KW - AVM

KW - cerebral aneurysm

KW - hematoma

KW - other stroke treatment – surgical

KW - subarachnoid hemorrhage

KW - intracranial vascular malformation

KW - endosvascular treatment

KW - natural-history

KW - hemorrhage

KW - management

KW - pressure

KW - cohort

KW - adults

KW - SIVMS

U2 - 10.1161/STROKEAHA.108.523662

DO - 10.1161/STROKEAHA.108.523662

M3 - Article

VL - 39

SP - 3216

EP - 3221

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 12

ER -