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• W3189154749 abstract "A brain arteriovenous malformation (bAVM) is vascular disorder which can lead to significant morbidity and mortality. Intracranial hemorrhage is the most common presentation followed by epilepsy, headache, and focal neurological deficits. Intracranial hemorrhage can lead to a decline in neurological function, even though the risk for this decline is lower than in patients with spontaneous hemorrhage. Predicting more accurately the risk of hemorrhage and the outcome after hemorrhage can help physicians to manage bAVM patients better regarding clinical decision-making. However, the knowledge about bAVM hemorrhage-risk is still limited. This thesis is aimed to explore characteristics and complications of brain arteriovenous malformation. There are three parts in the thesis. The first part aimed to identify molecular signatures, defined as genetic profiles, protein expression status or cellular signaling pathways, which are associated with bAVM-related hemorrhage. To reach the aim, we performed a systemic review according to the PRISMA guideline. After a full literature search, 3,108 articles were identified of which 31 were included after removal of duplication, abstract screening and full text screening. Several genetic polymorphisms, such as IL-6, IL-1β and TNF-α, were identified which rise the risk of bAVM rupture by increasing the expression of certain inflammatory cytokines. The second part aimed to investigate the change of bAVM characteristics after partial embolization. Embolization plays an important role in bAVM treatment, even though, only in a small proportion of cases (varying between 23.5% and 51.1%) a complete obliteration can be achieved with embolization alone. Partial embolization of the bAVM can lead to angiogenesis and those patients were also found to have a higher risk of hemorrhage than the patients without treatment. There is a limited number of studies investigating the long-term change of bAVM characteristics after partial-embolization. A case-series study was performed to analyze the change of bAVM characteristics over time after partial embolization. Nine patients were included in this study. Volume of bAVM nidus was decreased after first embolization, however, the volume increased significantly over a median interval of 101 months, both in comparison to the volumes before and after first embolization. The Spetzler-Martin grade changed in only one patient, however, the supplemental AVM score changed in four patients with a significant difference between initial and latest follow-up. The last part investigated whether surgically treated patients with bAVM-intracranial hemorrhage (ICH) fare better than surgically treated patients with spontaneous intracranial hemorrhage (SICH) regarding short- and long-term functional outcome. To achieve this goal, a retrospective analysis of prospectively collected data was performed. We found that patients with a bAVM who need surgical evacuation of an ICH have a more favorable outcome than surgically treated patients with spontaneous ICH, even after correction for confounding factors, such as younger age and less premorbid hypertension. In summary, risk assessment of bAVM hemorrhage might benefit from a combination of clinical information, biomarker(s) and clinical neuroimaging. Inflammation-related molecular signatures are potential biomarkers which can help to better predict the risk of bAVM related hemorrhage. As characteristics of bAVM are changing over years after partial embolization, a reassessment of obliterating the complete nidus is recommended in those patients. Patients who suffer ICH due to a bAVM should be treated aggressively, because these patients tend to have a better outcome than after a spontaneous ICH. In conclusion, these preclinical, radiological and clinical studies showed important baseline information, which can be used for future studies, such as search for biomarkers for bAVM hemorrhage and optimization of clinical decision-making, such as follow-up after partial embolization and treatment of bAVM related intracranial hemorrhage." @default.
• W3189154749 created "2021-08-16" @default.
• W3189154749 creator A5013619916 @default.
• W3189154749 date "2021-01-01" @default.
• W3189154749 modified "2023-09-27" @default.
• W3189154749 title "Exploring Characteristics and Complications of Brain Arteriovenous Malformations" @default.
• W3189154749 doi "https://doi.org/10.5167/uzh-205403" @default.
• W3189154749 hasPublicationYear "2021" @default.
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