title: European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH).
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.
authors.affiliation: Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy. marco.cenzato@ospedaleniguarda.it.
authors.forename: Marco
authors.identifier: 0000-0003-0283-7421
authors.initials: M
authors.lastname: Cenzato
authors.affiliation: Neuroradiology, Metropolitan Hospital Niguarda, Milan, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Boccardi
authors.affiliation: Neurology, Methodologist, IRCCS Istituto Mario Negri, Milan, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
authors.affiliation: Neurosurgery, Charitè Universitatetsmedizin, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
authors.affiliation: Neuroradiology, National Institute of NeuroScience, Budapest, Hungary.
authors.forename: Istvan
authors.initials: I
authors.lastname: Szikora
authors.affiliation: Radiosurgery, Ospedale Villa Maria di Cotignola, Ravenna, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Motti
authors.affiliation: Neurosurgery, UniversitaetsSpital, Zurich, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
authors.affiliation: Neurosurgery, Inselspital, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.affiliation: Neurosurgery, Burdenko Hospital, Moscow, Russia.
authors.forename: Shalva
authors.initials: S
authors.lastname: Eliava
authors.affiliation: Neurosurgery and Neuroradiology, University Hospital, Lintz, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Gruber
authors.affiliation: Neurosurgery, National Hospital, Oslo, Norway.
authors.forename: Torstein R
authors.initials: TR
authors.lastname: Meling
authors.affiliation: Neurosurgery, University Hospital, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Niemela
authors.affiliation: Neurosurgery, Ospedale Maggiore Civile, Verona, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pasqualin
authors.affiliation: Radiosurgery, Burdenko Hospital, Moscow, Russia.
authors.forename: Andrey
authors.initials: A
authors.lastname: Golanov
authors.affiliation: Radiosurgery, Singapore Gamma Knife Center, Singapore, Singapore.
authors.forename: Bengt
authors.initials: B
authors.lastname: Karlsson
authors.affiliation: Radiosurgery, Thornbury Radiosurgery Centre, Sheffield, UK.
authors.forename: Andras
authors.initials: A
authors.lastname: Kemeny
authors.affiliation: Radiosurgery, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Roman
authors.initials: R
authors.lastname: Liscak
authors.affiliation: Radiosurgery, Bupa Cromwell Hospital, London, UK.
authors.forename: Bodo
authors.initials: B
authors.lastname: Lippitz
authors.affiliation: Radiosurgery, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Matthias
authors.initials: M
authors.lastname: Radatz
authors.affiliation: Radiosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: La Camera
authors.affiliation: Neuroradiology, Krupp Hospital, Hessen, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Chapot
authors.affiliation: Neuroradiology, Cerrahpaşa Medical Faculty, İstanbul University, Istanbul, Turkey.
authors.forename: Civan
authors.initials: C
authors.lastname: Islak
authors.affiliation: Neuroradiology, Bicetre University Hospital, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Spelle
authors.affiliation: Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Debernardi
authors.affiliation: Neurology, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Agostoni
authors.affiliation: Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Revay
authors.affiliation: Neurosurgery, Macquaire University, Sydney, Australia.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Morgan
mesh_terms: D003226:Congresses as Topic; D005062:European Union; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000592:standards*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012042:Registries / Q000592:standards
keywords: ARUBA; Arteriovenous malformation; Consensus Conference; EANS; EGKS; ESMINT; Unruptured brain AVM