Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

Mingze Wang; Yuming Jiao; Chaofan Zeng; Chaoqi Zhang; Qiheng He; Yi Yang; Wenjun Tu; Hancheng Qiu; Huaizhang Shi; Dong Zhang; Dezhi Kang; Shuo Wang; A-Li Liu; Weijian Jiang; Yong Cao; Jizong Zhao

doi:10.3389/fneur.2021.651663

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

Front Neurol. 2021 Jun 9:12:651663. doi: 10.3389/fneur.2021.651663. eCollection 2021.

Authors

Mingze Wang^{1

2

3

4}, Yuming Jiao^{1

2

3

4}, Chaofan Zeng^{1

2

3

4}, Chaoqi Zhang^{1

2

3

4}, Qiheng He^{1

2

3

4}, Yi Yang^{1

2

3

4}, Wenjun Tu^{1

2

3

4}, Hancheng Qiu^{1

2

3

4}, Huaizhang Shi⁵, Dong Zhang^{1

2

3

4}, Dezhi Kang⁶, Shuo Wang^{1

2

3

4}, A-Li Liu^{1

2

3

4

7}, Weijian Jiang⁸, Yong Cao^{1

2

3

4}, Jizong Zhao^{1

2

3

4

9}

Affiliations

¹ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing, China.
³ Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
⁴ Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
⁵ Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
⁶ Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
⁷ Gamma Knife Center, Beijing Neurosurgical Institute, Beijing, China.
⁸ Department of Vascular Neurosurgery, Chinese People's Liberation Army Rocket Army Characteristic Medical Center, Beijing, China.
⁹ Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China.

Abstract

Aim: The aim of this guideline is to present current and comprehensive recommendations for the management of brain arteriovenous malformations (bAVMs) located in eloquent areas. Methods: An extended literature search on MEDLINE was performed between Jan 1970 and May 2020. Eloquence-related literature was further screened and interpreted in different subcategories of this guideline. The writing group discussed narrative text and recommendations through group meetings and online video conferences. Recommendations followed the Applying Classification of Recommendations and Level of Evidence proposed by the American Heart Association/American Stroke Association. Prerelease review of the draft guideline was performed by four expert peer reviewers and by the members of Chinese Stroke Association. Results: In total, 809 out of 2,493 publications were identified to be related to eloquent structure or neurological functions of bAVMs. Three-hundred and forty-one publications were comprehensively interpreted and cited by this guideline. Evidence-based guidelines were presented for the clinical evaluation and treatment of bAVMs with eloquence involved. Topics focused on neuroanatomy of activated eloquent structure, functional neuroimaging, neurological assessment, indication, and recommendations of different therapeutic managements. Fifty-nine recommendations were summarized, including 20 in Class I, 30 in Class IIa, 9 in Class IIb, and 2 in Class III. Conclusions: The management of eloquent bAVMs remains challenging. With the evolutionary understanding of eloquent areas, the guideline highlights the assessment of eloquent bAVMs, and a strategy for decision-making in the management of eloquent bAVMs.

Keywords: assessment; brain arteriovenous malformation; eloquent area; guideline; treatment.

Publication types

Review