Delayed versus immediate intervention of ruptured brain arteriovenous malformations: A case report

Table 1 Summary of the current evidence on delayed versus immediate treatment of ruptured brain arteriovenous malformations

Ref.	Time from ictus (rupture)	bAVM type and SMG	Modality of definitive treatments	Number of subjects	Age	Outcome	Follow-up period	Result
Bartolomeo et al[6], 2021	48 h; > 48 h	I-IV	Surgery; multimodal evacuation of hematoma	25	Mean age 38 and 45.55	mRS score	3 mo and 1 yr	Surgery after rest period is better, but early surgery seems reasonable for young patients
Mansur et al[7], 2021	48 h; > 48 h	I-IV	Targeted embolization; surgery; combination of delayed therapy; observation	32 acute; 284 non-acute	Mean age of acute: 32; non acute: 284	Change in mRS score and clinical outcome/re-rupture	Mean 3.2 ± 1.4 yr	Delayed curative treatment preferred. Acute targeted embolization warranted for weak points
Beecher et al[8], 2017	Delayed only: Minimal 4 wk post-hemorrhage	N/A	Radiation; surgery; embolization	102	N/A	Time to treatment failure (re-hemorrhage or neurological decline)	Median 248 d	6 (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 h	I-IV	Embolization; GK SRS; microsurgical resection	78	Median age 45	Mean mRS grading	Mean 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], 2019	Immediate embolization (time not defined) followed by delayed GK-SRS	III-IV	Embolization and SRS combination	16	Mean age 46.63 yr	mRS score	45.4 21.43 mo	Improvement of mRS score and no recurrent hemorrhage
van Rooij et al[11], 2012	Acute phase: Within 10 d of ictus	N/A	Embolization with either coils or Onyx	23	Mean age 42 yr	Obliteration status; hemorrhage recurrence; mortality	21 mo mean	1 death (following surgical evacuation of frontal hematoma); 13 patients had complete obliteration; No new hemorrhage
Andreou et al[12], 2008	Median 2 wk after ictus (range 1-28 wk)	Micro-AVM; SMG N/A	Embolization	25	N/A	Procedure-related complications; obliteration status; re-hemorrhage	6 mo	3 complications; 22 complete obliterations; 2 recurrences
Stemer et al[13], 2013	Acute phaseMedian 4 d after ictus(Range 8-75)	I-VI	Embolization (Onyx only)	21	Mean age 38 yr	Procedure-related complications; obliteration status; re-hemorrhage; GOS	7.5 mo mean	2 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], 2009	Acute phase (within 6 d of ictus)	I-II	Radical AVM surgical removal + hematoma evacuation	27	Mean age 41.3 yr	GOS; rehemorrhage; mortality	22 mo mean	85% favorable functional outcome (GOS: good recovery – moderate disability); 2 re-hemorrhages; 7.4% mortality
Kuhmonen et al[[15], 2005	Acute phase (within 4 d of ictus)	1-V	Craniotomy and extirpation; ventricular drainage; embolization	49	Mean age 32.8	GOS; mortality	2-3 mo	More than half of the patients had a good functional outcome; Mortality 12.2 %

bAVM: Brain arteriovenous malformation; GOS: Glasgow outcome scale; GK-SRS: Gamma-knife stereotactic radiation surgery; SMG: Spletzer-Martin Grade.