Registry of Multimodality Treatment for Brain Arteriovenous Malformation in China
Registry of Multimodality Treatment for Brain Arteriovenous Malformation in China
This study is a multi-center, prospective, registry study. All patients are divided into
 experimental group and control group according to treatment modalities. Patients of
 experimental group is strictly in accordance with standardized multi-disciplinary treatment
 protocols and meet the following criteria: 1. A multi-disciplinary conference discussion; 2.
 Detailed preoperative evaluation based on CT, MRI, fMRI and DSA. 3. Treatment modalities meet
 the following treatment criteria（craniotomy，embolization and Stereotactic radiosurgery）. The
 control group was patients who had not been treated according to a multi-disciplinary
 treatment protocol.

 Patient baseline data, AVM angioarchitectural features, surgical information, and follow-up
 information were registered. All patients were evaluated for neurofunction at baseline, 24
 hours after surgery, and 6 months (For neurosurgery and endovascular therapy) or 3 years (For
 stereotactic radiosurgery). Main observation endpoints: 1. Overall cure rate of AVM in
 experimental group and control group; 2. Overall complication rate and clinical outcome in
 experimental group and control group; 3. AVM bleeding rate and rebleeding rate in
 experimental group and control group. Secondary observation endpoint: improvement of clinical
 symptoms (epilepsy, headache, neurological dysfunction) at discharge and at last follow-up.
This study is a multi-center, prospective registry study led by Beijing Tiantan Hospital, and
 a number of comprehensive hospitals in China, aiming to uncover the treatment result of AVM
 in Real-World in China and discover a standard diagnosis and treatment process for the
 comprehensive treatment of arteriovenous malformations. This study lasted for 5 years and was
 an observational study. All patients were enrolled prospectively, and the study will not
 influence the choice of treatment modalities. All the patients clinical baseline data and
 imaging data were stored through a cloud server to facilitate the input work at different
 locations and at different times. According to different treatment modalities, patients
 receive corresponding follow-up procedures. Through the final follow-up data, the differences
 in the prognosis of patients under different treatment modalities are compared, and the best
 diagnosis and treatment modality for arteriovenous malformations is obtained. Patients of
 experimental group is discussed at multi-disciplinary conference and must meet the following
 standard treatment criteria:

 Treatment criteria for craniotomy: 1. For patients with a history of rupture and bleeding: a.
 If the lesion is not located in the deep functional area, surgical treatment is recommended;
 b. If the lesion is multi-system blood supply or high blood flow, the volume is large, and
 with a deep blood supply, hybrid surgery (embolization + resection) can be performed; c. If
 the lesion is located in the deep functional area, craniotomy is not recommended. 2. For
 patients with unruptured hemorrhage: a. If the lesion is not located in the deep brain
 tissue, and is not located in an important functional area or the fiber bundle is more than
 5mm away from the lesion, then surgery or combined surgery can be performed; b. If the lesion
 is located in the deep brain tissue, important functional areas or fiber bundles are less
 than 5mm away from the lesion, craniotomy is not recommended; c. If the lesion does not have
 the above characteristics, surgical resection alone can be performed.

 Interventional embolization treatment standards: 1. Ruptured bAVM should be actively treated.
 If there is no need for craniotomy to clear the hematoma in the acute phase, DSA should be
 performed 2-6 weeks after hemorrhage, and individualized treatment plans should be developed
 and actively treated. 2. Unruptured bAVM, if there are bleeding-related risk factors
 (aneurysm or high-flow fistula), relevant risk factors should be actively treated; When
 stereotactic radiation is planned, active treatment is required for volume reduction(10cm3)
 when craniotomy was planned, preoperative embolization for flow reduction is recommended; 3.
 Unruptured bAVM, without the above risk factors, conservative treatment was suggested if
 symptoms could be well controlled.

 Stereotactic radiosurgery standard treatment: 1. No history of bleeding: Patients with no
 indications for craniotomy and with appropriate volume for radiosurgery, and poor symptom
 controlled. Pre-treatment imaging assessment DSA (required) and enhanced MRI was required to
 clarify the structure of the malformation; 2. There is a history of bleeding: the period
 between bleeding time and the time of consultation is less than 3 months, it is recommended
 to wait head-enhanced MRI and DSA were performed after the hemorrhage was absorbed (3 months)
 to confirm the vascular architecture.
Inclusion Criteria:

 1. The diagnosis of AVM was confirmed with digital subtraction angiography (DSA) and/or
 magnetic resonance imaging(MRI).

 2. Patients with complete clinical and imaging data.

 3. Patient or patient's legal representative agreed to collection of information for this
 study and signed informed consent.

 Exclusion Criteria:

 1. Received other treatment (surgery, embolization or SRS)before inclusion, and could not
 provide the treatment data such as imaging data before or after treatment;

 2. Expected survival time is less than 6 months