| Title: |
Conservative management of brain arteriovenous malformations: results of the prospective observation registry of a pragmatic trial |
| Authors: |
Darsaut, Tim; Gentric, Jean-Christophe; Heppner, Jonathan; Lopez, Camille; Jabre, Roland; Iancu, Daniela; Roy, Daniel; Weill, Alain; Bojanowski, Michel; Chaalala, Chiraz; Comby, Pierre-Olivier; Roberge, David; Cognard, Christophe; Januel, Anne-Christine; Sabatier, Jean-Francois; Desal, Hubert; Roualdes, Vincent; Ferre, Jean-Christophe; Alias, Quentin; Papagiannaki, Chrysanthi; Derrey, Stéphane; Smajda, Stanislas; Aldea, Sorin; Gaberel, Thomas; Barbier, Charlotte; Barreau, Xavier; Marnat, Gaultier; Jecko, Vincent; Anxionnat, Rene; Merlot, Isabelle; Nguyen, Thanh; Abdalkader, Mohamad; Dumot, Chloe; Riva, Roberto; Graillon, Thomas; Troude, Lucas; Kerleroux, Basile; Ollivier, Irene; Beaujeux, Remy; Boulouis, Grégoire; Planty-Bonjour, Alexia; Spelle, Laurent; Chalumeau, Vanessa; Naggara, Olivier; Lefevre, Pierre-Henri; Le Corre, Marine; Shotar, Eimad; Carlson, Andrew; Biondi, Alessandra; Thines, Laurent; Tawk, Rabih; Huynh, Thien; Fahed, Robert; Findlay, J. Max; Chabert, Emmanuel; Zehr, Justine; Gevry, Guylaine; Klink, Ruby; Viard, Geraldine; Magro, Elsa; Raymond, Jean; ,; O’kelly, Cian; Chow, Michael; Rempel, Jeremy; Lesiuk, Howard; Drake, Brian; dos Santos, Marlene; Nonent, Michel; Ognard, Julien; El-Aouni, Mourad Cheddad; Seizeur, Romuald; Timsit, Serge; Pradier, Olivier; Boursier, Romain; Thillays, François; Piotin, Michel; Blanc, Raphael; Sabatier, Jean-François; Calviere, Lionel; Gauvrit, Jean-Yves; Eugene, François; Boucherit, Julien; Morandi, Xavier; Lecouillard, Isabelle; Briens, Aurelien; Ronziere, Thomas; Vannier, Stephane; Trystram, Denis; Rodriguez-Regent, Christine; Emery, Evelyne; Touze, Emmanuel; Eker, Omer; Pellisou-Guyotat, Isabelle; Guyotat, Jacques; Berhouma, Monsef; Dumot, Chloé; Bougaci, Nassim; Charbonnier, Guillaume; Bracard, Serge; Anxionnat, René; Gory, Benjamin; Civit, Thierry; Bernier-Chastagner, Valérie; Penchet, Guillaume; Gimbert, Edouard; Huchet, Aymeri; Herbreteau, Denis; Bibi, Richard; Ifergan, Héloïse; Janot, Kévin; Velut, Stéphane; Brunel, Hervé; Roche, Pierre-Hugues; Peyriere, Hadrien; Kaya, Jean-Marc; Touta, Adamou; Boissonneau, Sébastien; Clarençon, Frédéric; Sourour, Nader; Lenck, Stéphanie; Premat, Kévin; Boch, Anne-Laure; Cornu, Philippe; Nouet, Aurélien; Costalat, Vincent; Bonafe, Alain; Dargazanli, Cyril; Gascou, Gregory; Riquelme, Carlos; Beaujeux, Rémy; Pop, Raoul; Proust, François; Cebula, Hélène; Ollivier, Irène; Spatola, Giorgio; Gallas, Sophie; Ikka, Léon; Mihalea, Cristian; Ozanne, Augustin; Caroff, Jildaz; Mounayer, Charbel; Rouchaud, Aymeric; Caire, François; Ricolfi, Frédéric; Thouant, Pierre; Cao, Catherine; Mourier, Klaus-Luc; Farah, Walid; Silva, Luciana Alves Oliveira; de Lima Froio, Nayara; Silva, Gisele Sampaio; Mont’alverne, Francisco; Martins, Jose Luri; Mendes, George Nunes; Miranda, Rodrigo Rivera |
| Contributors: |
Marseille medical genetics - Centre de génétique médicale de Marseille (MMG); Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM); Institut Marseille Maladies Rares (MarMaRa); Aix Marseille Université (AMU); Service de neurochirurgie CHU Marseille; Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Timone CHU - APHM (TIMONE) |
| Source: |
ISSN: 0022-3085 ; Journal of Neurosurgery ; https://amu.hal.science/hal-05507979 ; Journal of Neurosurgery, 2025, 142 (3), pp.637-646. ⟨10.3171/2024.5.JNS24623⟩. |
| Publisher Information: |
CCSD; American Association of Neurological Surgeons |
| Publication Year: |
2025 |
| Collection: |
Inserm: HAL (Institut national de la santé et de la recherche médicale) |
| Subject Terms: |
brain arteriovenous malformation; care trial; conservative management; observation registry; randomized trial; ruptured AVM; unruptured AVM; vascular disorders; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology |
| Description: |
International audience ; OBJECTIVE Many patients recruited in the Treatment of Brain Arteriovenous Malformations Study (TOBAS) are managed conservatively. The aim of this study was to monitor what happened to those patients. METHODS TOBAS comprises two randomized controlled trials and multiple prospective registries. All patients with brain arteriovenous malformations (AVMs) can participate. This report concerns patients selected for conservative management. The primary trial outcome measure is related death or dependency (modified Rankin Scale [mRS] score > 2) at 10 years. Secondary outcomes include intracranial hemorrhages, nonhemorrhagic neurological events, and serious adverse events (SAEs). For this report, outcome results are presented using patient-years, Kaplan-Meier survival curves, and Cox log-rank tests. There was no blinding. RESULTS From June 2014 to May 2021, 1010 patients were recruited, of whom 498 (49%) were proposed the prospective observation registry. After exclusions, 434 (87%) patients remained for analysis. The majority of patients had unruptured AVMs (378/434 [87%]), of which 195 (52%) were low grade (Spetzler-Martin grade I or II). During a mean follow-up period of 3.2 years (total 1368 patient-years), the primary outcome occurred in 23 of 434 (5%) patients, corresponding to an incidence of 1.7 (95% CI 1.1–2.5) per 100 patient-years. For unruptured AVMs the incidence was 1.1 (95% CI 0.7–1.9) per 100 patient-years, and for low-grade unruptured AVMs it was 0.6 (95% CI 0.2–1.7) per 100 patient-years. Poor outcomes were more frequent in patients with a history of rupture (HR 5.6 [95% CI 2.4–13.0], p < 0.001), infratentorial AVMs (HR 2.9 [95% CI 1.1–7.3], p = 0.027), and age ≥ 55 years (HR 3.2 [95% CI 1.4–7.6], p = 0.007). Major intracranial hemorrhage occurred in 35 of 434 (8%) patients (incidence of 2.6 [95% CI 1.9–3.6] per 100 patient-years; 2.0 [95% CI 1.3–2.9] per 100 patient-years for unruptured AVMs and 1.3 [95% CI 0.6–2.6] per 100 patient-years for low-grade unruptured AVMs). ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.3171/2024.5.JNS24623 |
| Availability: |
https://amu.hal.science/hal-05507979; https://amu.hal.science/hal-05507979v1/document; https://amu.hal.science/hal-05507979v1/file/j-neurosurg-article-p637.pdf; https://doi.org/10.3171/2024.5.JNS24623 |
| Rights: |
https://creativecommons.org/licenses/by-nc-nd/4.0/ ; info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.AD224AB2 |
| Database: |
BASE |