TY - JOUR
T1 - Management of ruptured brain arteriovenous malformations
AU - Zacharia, Brad E.
AU - Vaughan, Kerry A.
AU - Jacoby, Adam
AU - Hickman, Zachary L.
AU - Bodmer, Daniel
AU - Connolly, E. Sander
N1 - Funding Information:
Acknowledgments This work was supported by a grant from the Doris Duke Charitable Foundation to Columbia University to fund Clinical Research Fellow KAV. Source of Funding: Department of Neurological Surgery, Doris Duke Charitable Foundation Disclosure No potential conflicts of interest relevant to this article were reported.
PY - 2012/8
Y1 - 2012/8
N2 - Intracranial arteriovenous malformations (AVMs) are a common cause of stroke in younger patients, and often present as intracerebral hemorrhages (ICH), associated with 10 % to 30 % mortality. Patients who present with a hemorrhage from an AVM should be initially stabilized according to acute management guidelines for ICH. The characteristics of a lesion including its size, location in eloquent tissue, and high-risk features will influence risk of rupture, prognosis, as well as help guide management decisions. Given that rupture is associated with an increased risk of 6 % re-rupture in the year following the initial hemorrhage, versus 1 % to 3 % predicted annual risk in non-ruptured lesions only, definitive treatment is encouraged after ICH stabilization. A rest period of 2 to 6 weeks after hemorrhage is recommended before definitive treatment to avoid disrupting friable parenchyma and the hematoma. Treatment may consist of endovascular embolization, surgical resection, radiosurgery, or a combination of these three interventions based on the lesion.
AB - Intracranial arteriovenous malformations (AVMs) are a common cause of stroke in younger patients, and often present as intracerebral hemorrhages (ICH), associated with 10 % to 30 % mortality. Patients who present with a hemorrhage from an AVM should be initially stabilized according to acute management guidelines for ICH. The characteristics of a lesion including its size, location in eloquent tissue, and high-risk features will influence risk of rupture, prognosis, as well as help guide management decisions. Given that rupture is associated with an increased risk of 6 % re-rupture in the year following the initial hemorrhage, versus 1 % to 3 % predicted annual risk in non-ruptured lesions only, definitive treatment is encouraged after ICH stabilization. A rest period of 2 to 6 weeks after hemorrhage is recommended before definitive treatment to avoid disrupting friable parenchyma and the hematoma. Treatment may consist of endovascular embolization, surgical resection, radiosurgery, or a combination of these three interventions based on the lesion.
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U2 - 10.1007/s11883-012-0257-9
DO - 10.1007/s11883-012-0257-9
M3 - Article
C2 - 22623087
AN - SCOPUS:84865606057
SN - 1523-3804
VL - 14
SP - 335
EP - 342
JO - Current atherosclerosis reports
JF - Current atherosclerosis reports
IS - 4
ER -