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European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH)

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Abstract

In December of 2016, a Consensus Conference on unruptured AVM treatment, involving 24 members of the three European societies dealing with the treatment of cerebral AVMs (EANS, ESMINT, and EGKS) was held in Milan, Italy. The panel made the following statements and general recommendations: (1) Brain arteriovenous malformation (AVM) is a complex disease associated with potentially severe natural history; (2) The results of a randomized trial (ARUBA) cannot be applied equally for all unruptured brain arteriovenous malformation (uBAVM) and for all treatment modalities; (3) Considering the multiple treatment modalities available, patients with uBAVMs should be evaluated by an interdisciplinary neurovascular team consisting of neurosurgeons, neurointerventionalists, radiosurgeons, and neurologists experienced in the diagnosis and treatment of brain AVM; (4) Balancing the risk of hemorrhage and the associated restrictions of everyday activities related to untreated unruptured AVMs against the risk of treatment, there are sufficient indications to treat unruptured AVMs grade 1 and 2 (Spetzler–Martin); (5) There may be indications for treating patients with higher grades, based on a case-to-case consensus decision of the experienced team; (6) If treatment is indicated, the primary strategy should be defined by the multidisciplinary team prior to the beginning of the treatment and should aim at complete eradication of the uBAVM; (7) After having considered the pros and cons of a randomized trial vs. a registry, the panel proposed a prospective European Multidisciplinary Registry.

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Acknowledgments

We gratefully acknowledge the financial support by B. Braun that offered an unrestricted educational grant.

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Authors and Affiliations

  1. Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Marco Cenzato, Alberto Debernardi & Martina Revay

  2. Neuroradiology, Metropolitan Hospital Niguarda, Milan, Italy

    Edoardo Boccardi

  3. Neurology, Methodologist, IRCCS Istituto Mario Negri, Milan, Italy

    Ettore Beghi

  4. Neurosurgery, Charitè Universitatetsmedizin, Berlin, Germany

    Peter Vajkoczy

  5. Neuroradiology, National Institute of NeuroScience, Budapest, Hungary

    Istvan Szikora

  6. Radiosurgery, Ospedale Villa Maria di Cotignola, Ravenna, Italy

    Enrico Motti

  7. Neurosurgery, UniversitaetsSpital, Zurich, Switzerland

    Luca Regli

  8. Neurosurgery, Inselspital, Bern, Switzerland

    Andreas Raabe

  9. Neurosurgery, Burdenko Hospital, Moscow, Russia

    Shalva Eliava

  10. Neurosurgery and Neuroradiology, University Hospital, Lintz, Austria

    Andreas Gruber

  11. Neurosurgery, National Hospital, Oslo, Norway

    Torstein R. Meling

  12. Neurosurgery, University Hospital, Helsinki, Finland

    Mika Niemela

  13. Neurosurgery, Ospedale Maggiore Civile, Verona, Italy

    Alberto Pasqualin

  14. Radiosurgery, Burdenko Hospital, Moscow, Russia

    Andrey Golanov

  15. Radiosurgery, Singapore Gamma Knife Center, Singapore, Singapore

    Bengt Karlsson

  16. Radiosurgery, Thornbury Radiosurgery Centre, Sheffield, UK

    Andras Kemeny

  17. Radiosurgery, Na Homolce Hospital, Prague, Czech Republic

    Roman Liscak

  18. Radiosurgery, Bupa Cromwell Hospital, London, UK

    Bodo Lippitz

  19. Radiosurgery, Royal Hallamshire Hospital, Sheffield, UK

    Matthias Radatz

  20. Radiosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Alessandro La Camera

  21. Neuroradiology, Krupp Hospital, Hessen, Germany

    René Chapot

  22. Neuroradiology, Cerrahpaşa Medical Faculty, İstanbul University, Istanbul, Turkey

    Civan Islak

  23. Neuroradiology, Bicetre University Hospital, Paris, France

    Laurent Spelle

  24. Neurology, Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Elio Agostoni

  25. Neurosurgery, Macquaire University, Sydney, Australia

    Michael K. Morgan

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  1. Marco Cenzato
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Correspondence to Marco Cenzato.

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Cenzato, M., Boccardi, E., Beghi, E. et al. European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH). Acta Neurochir 159, 1059–1064 (2017). https://doi.org/10.1007/s00701-017-3154-8

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  • DOI: https://doi.org/10.1007/s00701-017-3154-8

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