Surgical treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial
- Type de publi. : Article dans une revue
- Date de publi. : 01/09/2022
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Auteurs :
Tim DarsautElsa MagroMichel BojanowskiChiraz ChaalalaLorena NicoEmma BacchusRuby KlinkDaniela IancuAlain WeillDaniel RoyJean-Francois SabatierChristophe CognardAnne-Christine JanuelIsabelle Pelissou-GuyotatOmer EkerPierre-Hugues RocheThomas GraillonHervé BrunelFrancois ProustRémy BeaujeuxSorin AldeaMichel PiotinPhilippe CornuEimad ShotarThomas GaberelCharlotte BarbierMarine Le CorreVincent CostalatVincent JeckoXavier BarreauXavier MorandiJean-Yves GauvritStéphane DerreyChrysanthi PapagiannakiThanh NguyenMohamad AbdalkaderRabih TawkThien HuynhGeraldine ViardGuylaine GevryJean-Christophe GentricJean RaymondJean RaymondJeremy RempelCian O’kellyMichael ChowJ. Max FindlayRobert FahedHoward LesiukBrian DrakeMarlene Dos SantosRomuald SeizeurMichel NonentSerge TimsitOlivier PradierJulien OgnardMourad Cheddad El-AouniHubert DesalRomain BoursierFrançois ThillaysVincent RoualdesRaphael BlancLionel CalviereJean Yves GauvritIsabelle LecouillardElodie NouhaudHélène RaoultFrançois EugeneAnthony Le BrasJean-Christophe FerreChristophe PayaThomas RonziereDenis TrystramOlivier NaggaraChristine Rodriguez-RegentBasile KerlerouxEvelyne EmeryEmmanuel TouzeIsabelle Pellisou-GuyotatJacques GuyotatMonsef BerhoumaRoberto RivaChloé DumotAlessandra BiondiLaurent ThinesGuillaume CharbonnierNassim BougaciSerge BracardRené AnxionnatValérie Bernier-ChastagnerThierry CivitBenjamin GoryGuillaume PenchetEdouard GimbertGaulthier MarnatAymeri HuchetDenis HerbreteauGrégoire BoulouisStéphane VelutRichard BibiHéloïse IferganKévin JanotHadrien PeyriereJean-Marc KayaAdamou ToutaLucas TroudeSébastien BoissonneauAnne-Laure BochFrédéric ClarençonNader SourourAurélien NouetStéphanie LenckKévin PrematAlain BonafeCyril DargazanliGregory GascouPierre-Henri LefevreCarlos RiquelmeHélène CebulaIrène OllivierRaoul PopGiorgio SpatolaLaurent SpelleVanessa ChalumeauSophie GallasLéon IkkaCristian MihaleaAugustin OzanneJildaz CaroffEmmanuel ChabertCharbel MounayerAymeric RouchaudFrançois CaireFrédéric RicolfiCatherine CaoKlaus-Luc MourierPierre ThouantWalid FarahAndrew CarlsonLuciana Alves Oliveira SilvaNayara de Lima FroioGisele Sampaio SilvaFrancisco Mont’alverneJose Luri MartinsGeorge Nunes MendesRodrigo Rivera Miranda
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Organismes :
Provincial Laboratory for Public Health [Alberta, Canada]
Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé - Brest
Laboratoire de Traitement de l'Information Medicale
Université du Québec à Montréal = University of Québec in Montréal
Centre Hospitalier de l'Université de Montréal
Centre Hospitalier de l'Université de Montréal
Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
Provincial Laboratory for Public Health [Alberta, Canada]
Centre de recherche du CHU Sainte-Justine / Research Center of the Sainte-Justine University Hospital [Montreal, Canada]
Centre Hospitalier de l'Université de Montréal
EPI-PHARE
Laboratoire de Génie Informatique, de Production et de Maintenance
Service Neurochirurgie [CHU Toulouse]
Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
Hospices Civils de Lyon
Service de neuroradiologie [Lyon]
Aix Marseille Université
Hôpital Nord [CHU - APHM]
Marseille medical genetics - Centre de génétique médicale de Marseille
Institut Marseille Maladies Rares
Neurologie, maladies neuro-musculaires [Hôpital de la Timone - APHM]
Assistance Publique - Hôpitaux de Marseille
Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie
Service de radiologie [Strasbourg]
Département de Neuroradiologie [Strasbourg]
Hôpital Foch [Suresnes]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
CHU Pitié-Salpêtrière [AP-HP]
Physiopathologie et imagerie des troubles neurologiques
Service de Neurochirurgie [CHU Caen]
CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie
Hôpital Gui de Chauliac [CHU Montpellier]
Centre Hospitalier Universitaire de Bordeaux
Centre Hospitalier Universitaire de Bordeaux
Laboratoire Traitement du Signal et de l'Image
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Neuroimagerie: méthodes et applications
Service de Neurochirurgie [CHU Rouen]
Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
Institute for Research and Innovation in Biomedicine
Centre d'Investigation Clinique [CHU Rouen]
UNIROUEN - UFR Santé
CHU Rouen
National Institute of Veterinary Research [Hanoï]
Boston University School of Medicine
Hôpital de la Cavale Blanche - CHRU Brest
Hôpital de la Cavale Blanche - CHRU Brest
Groupe d'Etude de la Thrombose de Bretagne Occidentale
Centre Hospitalier de l'Université de Montréal
Centre Hospitalier de l'Université de Montréal
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
The Ottawa Hospital
- Publié dans Journal of Neurosurgery le 26/10/2020
Résumé : OBJECTIVE The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is a pragmatic study that includes 2 randomized trials and registries of treated or conservatively managed patients. The authors report the results of the surgical registry.
METHODS TOBAS patients are managed according to an algorithm that combines clinical judgment and randomized allocation. For patients considered for curative treatment, clinicians selected from surgery, endovascular therapy, or radiation therapy as the primary curative method, and whether observation was a reasonable alternative. When surgery was selected and observation was deemed unreasonable, the patient was not included in the randomized controlled trial but placed in the surgical registry. The primary outcome of the trial was mRS score > 2 at 10 years (at last follow-up for the current report). Secondary outcomes include angiographic results, perioperative serious adverse events, and permanent treatment-related complications leading to mRS score > 2.
RESULTS From June 2014 to May 2021, 1010 patients were recruited at 30 TOBAS centers. Surgery was selected for 229/512 patients (44%) considered for curative treatment; 77 (34%) were included in the surgery versus observation randomized trial and 152 (66%) were placed in the surgical registry. Surgical registry patients had 124/152 (82%) ruptured and 28/152 (18%) unruptured arteriovenous malformations (AVMs), with the majority categorized as low-grade Spetzler-Martin grade I–II AVM (118/152 [78%]). Thirteen patients were excluded, leaving 139 patients for analysis. Embolization was performed prior to surgery in 78/139 (56%) patients. Surgical angiographic cure was obtained in 123/139 all-grade (89%, 95% CI 82%–93%) and 105/110 low-grade (95%, 95% CI 90%–98%) AVM patients. At the mean follow-up of 18.1 months, 16 patients (12%, 95% CI 7%–18%) had reached the primary safety outcome of mRS score > 2, including 11/16 who had a baseline mRS score ≥ 3 due to previous AVM rupture. Serious adverse events occurred in 29 patients (21%, 95% CI 15%–28%). Permanent treatment-related complications leading to mRS score > 2 occurred in 6/139 patients (4%, 95% CI 2%–9%), 5 (83%) of whom had complications due to preoperative embolization.
CONCLUSIONS The surgical treatment of brain AVMs in the TOBAS registry was curative in 88% of patients. The participation of more patients, surgeons, and centers in randomized trials is needed to definitively establish the role of surgery in the treatment of unruptured brain AVMs. Clinical trial registration no.: NCT02098252 ( ClinicalTrials.gov )
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