Case Report
Copyright ©The Author(s) 2023.
World J Clin Cases. Mar 26, 2023; 11(9): 1992-2001
Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.1992
Table 1 Summary of the current evidence on delayed versus immediate treatment of ruptured brain arteriovenous malformations
Time from ictus (rupture)
bAVM type and SMG
Modality of definitive treatments
Number of subjects
Follow-up period
Bartolomeo et al[6], 2021 48 h; > 48 hI-IVSurgery; multimodal evacuation of hematoma25Mean age 38 and 45.55mRS score3 mo and 1 yrSurgery after rest period is better, but early surgery seems reasonable for young patients
Mansur et al[7], 2021 48 h; > 48 hI-IVTargeted embolization; surgery; combination of delayed therapy; observation32 acute; 284 non-acuteMean age of acute: 32; non acute: 284Change in mRS score and clinical outcome/re-ruptureMean 3.2 ± 1.4 yrDelayed curative treatment preferred. Acute targeted embolization warranted for weak points
Beecher et al[8], 2017Delayed only: Minimal 4 wk post-hemorrhageN/ARadiation; surgery; embolization102N/ATime to treatment failure (re-hemorrhage or neurological decline)Median 248 d6 (5.8%) new hemorrhage. Authors in support of delaying treatment for at least weeks to allow for neurologic improvement prior to intervention
Bir et al[9], 2016< 24 h; 24-48 h; > 48 hI-IVEmbolization; GK SRS; microsurgical resection78Median age 45 Mean mRS gradingMean mo 45.17 (1-223)Significant difference in mean mRS: Group < 24h vs > 48h (P = 0.01); Group 24-48 h vs > 48 h (P = 0.03)
Todnem et al[10], 2019Immediate embolization (time not defined) followed by delayed GK-SRSIII-IVEmbolization and SRS combination16Mean age 46.63 yrmRS score45.4 21.43 moImprovement of mRS score and no recurrent hemorrhage
van Rooij et al[11], 2012Acute phase: Within 10 d of ictusN/AEmbolization with either coils or Onyx23Mean age 42 yrObliteration status; hemorrhage recurrence; mortality21 mo mean1 death (following surgical evacuation of frontal hematoma); 13 patients had complete obliteration; No new hemorrhage
Andreou et al[12], 2008Median 2 wk after ictus (range 1-28 wk) Micro-AVM; SMG N/AEmbolization25N/AProcedure-related complications; obliteration status; re-hemorrhage6 mo3 complications; 22 complete obliterations; 2 recurrences
Stemer et al[13], 2013Acute phaseMedian 4 d after ictus(Range 8-75)I-VIEmbolization (Onyx only)21Mean age 38 yrProcedure-related complications; obliteration status; re-hemorrhage; GOS7.5 mo mean2 asymptomatic complications; 0 new hemorrhage; 7 complete obliterations after the first procedure; mean GOS improvement from 4.0 on presentation to 4.4 after first procedure
Pavesi et al[14], 2009Acute phase (within 6 d of ictus)I-IIRadical AVM surgical removal + hematoma evacuation 27Mean age 41.3 yrGOS; rehemorrhage; mortality22 mo mean85% favorable functional outcome (GOS: good recovery – moderate disability); 2 re-hemorrhages; 7.4% mortality
Kuhmonen et al[[15], 2005Acute phase (within 4 d of ictus)1-VCraniotomy and extirpation; ventricular drainage; embolization 49Mean age 32.8GOS; mortality2-3 moMore than half of the patients had a good functional outcome; Mortality 12.2 %