Januel, Anne-Christine

Mayo Clinic

Centre Hospitalier Universitaire de Toulouse

Citations 2

Conservative management of brain arteriovenous malformations: results of the prospective observation registry of a pragmatic trial

Gentric, Jean-Christophe, Heppner, Jonathan, Lopez, Camille, Jabre, Roland , Bojanowski, Michel W. , Chaalala, Chiraz , Januel, Anne-Christine, Sabatier, Jean-François, Desal, Hubert, Roualdes, Vincent , Alias, Quentin , Derrey, Stéphane , Gaberel, Thomas , Barbier, Charlotte , Barreau, Xavier , Anxionnat, René , Merlot, Isabelle, Nguyen, Thanh N., Abdalkader, Mohamad , Riva, Roberto, Troude, Lucas, Ollivier, Irène , Planty-Bonjour, Alexia, Chalumeau, Vanessa, Naggara, Olivier, Lefevre, Pierre-Henri, Corre, Marine Le, Carlson, Andrew P. , Thines, Laurent, Findlay, J. Max, Chabert, Emmanuel , Zehr, Justine , Klink, Ruby , Viard, Geraldine, Magro, Elsa, _, _, Raymond, Jean , Chow, Michael M. C., Findlay, J. Max , Lesiuk, Howard , Drake, Brian , Santos, Marlene dos, Lopez, Camille, Ognard, Julien, Seizeur, Romuald, Pradier, Olivier, Boursier, Romain, Thillays, F. , Januel, Anne-Christine , Sabatier, Jean-François, Calvière, Lionel , Gauvrit, Jean‐Yves , Eugene, François, Boucherit, Julien , Lecouillard, Isabelle, Briens, Aurélien, Ronzière, Thomas , Trystram, D. , Naggara, Olivier , Emery, Évelyne , Pellisou-Guyotat, Isabelle, Guyotat, Jacques, Berhouma, Monsef, Bougaci, Nassim , Bracard, Serge, Civit, Thierry, Bernier‐Chastagner, Valérie , Penchet, Guillaume, Gimbert, Edouard, Huchet, Aymeri, Herbreteau, Denis , Bibi, Richard , Ifergan, Héloïse , Janot, Kévin, Brunel, Hervé, Roche, Pièrre-Hugues , Peyrière, Hadrien, Kaya, Jean-Marc, Touta, Adamou, Boissonneau, Sébastien , Clarençon, Frédéric , Premat, Kévin, Boch, Anne‐Laure , Cornu, Philippe, Nouet, Aurélien , Costalat, Vincent , Gascou, Gregory, Riquelme, Carlos, Pop, Raoul, Proust, François, Cébula, H. , Spatola, Giorgio, Ikka, Léon , Ozanne, Augustin , Caroff, Jildaz , Rouchaud, Aymeric, Caire, François, Ricolfi, F. , Thouant, Pierre, Cao, Catherine, Mourier, Klaus-Luc, Farah, Walid, Silva, Luciana Alves Oliveira, Froio, Nayara de Lima, Mont’Alverne, Francisco J. A., Martins, Jose Luri, Miranda, Rodrigo Rivera, Rivera, Rodrigo , Ognard, Julien , Shotar, Eimad , Ognard, Julien , Darsaut, Tim E. , Iancu, Daniela , Roy, Daniel C. , Weill, Alain , Comby, Pierre‐Olivier , Roberge, David , Cognard, Christophe , Desal, Hubert , Ferré, Jean‐Christophe , Papagiannaki, Chrysanthi , Smajda, Stanislas , Aldéa, Sorin , Marnat, Gaultier , Jecko, Vincent , Dumot, Chloé , Riva, Roberto , Graillon, Thomas , Troude, Lucas , Kerleroux, Basile , Beaujeux, Rémy , Boulouis, Grégoire , Spelle, Laurent , Chalumeau, Vanessa , Lefèvre, Pierre-Henri , Corre, Marine Le, Shotar, Eimad , Biondi, Alessandra , Tawk, Rabih G. , Huynh, Thien , Fahed, Robert , Gévry, Guylaine , _, _, O'Kelly, Cian J , Rempel, Jeremy L , Santos, Marlene dos, Gentric, Jean‐Christophe , Lopez, Camille, Nonent, Michel , Aouni, Mourad Cheddad El , Timsit, Serge , Piotin, Michel , Blanc, Raphaël , Morandi, Xavier , Vannier, Stéphane , Rodriguez-Régent, Christine , Touzé, Emmanuel , Eker, Omer , Charbonnier, Guillaume , Gory, Benjamin , Velut, Stéphane , Sourour, Nader Antoine , Lenck, Stéphanie , Premat, Kévin , Bonafé, Alain , Dargazanli, Cyril , Gascou, Grégory , Corre, Marine Le, Gallas, Sophie , Mihalea, Cristian , Mounayer, Charbel , Thouant, Pierre , Nguyen, Thanh N. , Silva, Gisele Sampaio , Montalverne, Francisco Jose , Mendes, George Nilton Nunes

Journal of Neurosurgery | October 12, 2024 | Volume: No volume available | Issue: No issue available | Pages: 1-10

10.3171/2024.5.jns24623

OBJECTIVE Many patients recruited in the Treatment of Brain Arteriovenous Malformations Study (TOBAS) are managed conservatively. The aim of this study was to monitor what happened to those patients. METHODS TOBAS comprises two randomized controlled trials and multiple prospective registries. All patients with brain arteriovenous malformations (AVMs) can participate. This report concerns patients selected for conservative management. The primary trial outcome measure is related death or dependency (modified Rankin Scale [mRS] score > 2) at 10 years. Secondary outcomes include intracranial hemorrhages, nonhemorrhagic neurological events, and serious adverse events (SAEs). For this report, outcome results are presented using patient-years, Kaplan-Meier survival curves, and Cox log-rank tests. There was no blinding. RESULTS From June 2014 to May 2021, 1010 patients were recruited, of whom 498 (49%) were proposed the prospective observation registry. After exclusions, 434 (87%) patients remained for analysis. The majority of patients had unruptured AVMs (378/434 [87%]), of which 195 (52%) were low grade (Spetzler-Martin grade I or II). During a mean follow-up period of 3.2 years (total 1368 patient-years), the primary outcome occurred in 23 of 434 (5%) patients, corresponding to an incidence of 1.7 (95% CI 1.1–2.5) per 100 patient-years. For unruptured AVMs the incidence was 1.1 (95% CI 0.7–1.9) per 100 patient-years, and for low-grade unruptured AVMs it was 0.6 (95% CI 0.2–1.7) per 100 patient-years. Poor outcomes were more frequent in patients with a history of rupture (HR 5.6 [95% CI 2.4–13.0], p < 0.001), infratentorial AVMs (HR 2.9 [95% CI 1.1–7.3], p = 0.027), and age ≥ 55 years (HR 3.2 [95% CI 1.4–7.6], p = 0.007). Major intracranial hemorrhage occurred in 35 of 434 (8%) patients (incidence of 2.6 [95% CI 1.9–3.6] per 100 patient-years; 2.0 [95% CI 1.3–2.9] per 100 patient-years for unruptured AVMs and 1.3 [95% CI 0.6–2.6] per 100 patient-years for low-grade unruptured AVMs). Major AVM hemorrhages were more frequent in ruptured (HR 4.4 [95% CI 2.1–8.9], p < 0.001), large (HR 2.6 [95% CI 1.1–6.6], p = 0.039), and high-grade (HR 2.5 [95% CI 1.2–5.3], p = 0.013) AVMs and those with deep venous drainage (HR 2.1 [95% CI 1.1–4.2], p = 0.032). SAEs occurred in 48 of 434 (11%) patients (incidence of 3.6 [95% CI 2.7–4.8] per 100 patient-years). For unruptured AVMs the incidence was 2.8 (95% CI 2.0–4.0) per 100 patient-years, and for low-grade unruptured AVMs it was 1.8 (95% CI 1.0–3.2) per 100 patient-years. CONCLUSIONS Nearly half of TOBAS participants were observed. Rates of untoward neurological events were within expected boundaries.

Surgical treatment of brain arteriovenous malformations: clinical outcomes of patients included in the registry of a pragmatic randomized trial

Darsaut, Tim E. , Magro, Elsa, Bojanowski, Michel W., Chaalala, Chiraz , Nico, Lorena , Bacchus, Emma, Klink, Ruby , Sabatier, Jean-François, Januel, Anne-Christine , Pélissou-Guyotat, I., Roche, Pièrre-Hugues , Brunel, Hervé, Proust, F. , Cornu, Philippe, Gaberel, Thomas , Barbier, Charlotte , Corre, Marine Le, Costalat, Vincent , Jecko, Vincent , Barreau, Xavier , Gauvrit, Jean‐Yves , Derrey, Stéphane , Papagiannaki, Chrysanthi , Abdalkader, Mohamad , Viard, Geraldine, Raymond, Jean , _, _, _, _, Chow, Michael M. C., Findlay, J. Max , Lesiuk, Howard , Drake, Brian , Santos, Marlene dos, Seizeur, Romuald, Pradier, Olivier, Ognard, Julien, Aouni, Mourad Cheddad El , Boursier, Romain, Thillays, F. , Roualdes, Vincent , Calvière, Lionel , Gauvrit, J.Y., Lecouillard, Isabelle, Nouhaud, Elodie, Raoult, Hélène , Eugene, François, Paya, Christophe, Ronzière, Thomas , Trystram, D. , Naggara, Olivier, Emery, Évelyne , Pellisou-Guyotat, Isabelle, Guyotat, Jacques, Berhouma, Monsef, Riva, Roberto, Biondi, Alessandra , Thines, L. , Bougaci, Nassim , Bracard, Serge, Anxionnat, René , Bernier‐Chastagner, Valérie , Civit, Thierry, Penchet, Guillaume, Gimbert, Edouard, Marnat, Gaulthier, Huchet, Aymeri, Herbreteau, Denis , Bibi, Richard, Ifergan, Héloïse , Janot, Kévin, Peyrière, Hadrien, Kaya, Jean-Marc, Touta, Adamou, Troude, Lucas, Boissonneau, Sébastien , Boch, Anne‐Laure , Clarençon, Frédéric , Nouet, Aurélien , Premat, Kévin, Gascou, Gregory, Lefevre, Pierre-Henri, Riquelme, Carlos , Cébula, H. , Ollivier, Irène , Pop, Raoul, Spatola, Giorgio, Chalumeau, Vanessa, Ikka, Léon , Ozanne, Augustin , Caroff, Jildaz, Chabert, Emmanuel , Rouchaud, Aymeric, Caire, François, Ricolfi, F. , Cao, Catherine, Mourier, Klaus-Luc, Thouant, Pierre, Farah, Walid, Carlson, Andrew P. , Silva, Luciana Alves Oliveira, Froio, Nayara de Lima, Mont’Alverne, Francisco J. A., Martins, Jose Luri, Mendes, George Nilton Nunes , Miranda, Rodrigo Rivera, Rouchaud, Aymeric , Rivera, Rodrigo , Ognard, Julien , Shotar, Eimad , Rouchaud, Aymeric , Ognard, Julien , Bojanowski, Michel W. , Iancu, Daniela , Weill, Alain , Roy, Daniel C. , Cognard, Christophe , Eker, Omer , Graillon, Thomas , Beaujeux, Rémy , Aldéa, Sorin , Piotin, Michel , Shotar, Eimad , Corre, Marine Le, Morandi, Xavier , Nguyen, Thanh N. , Tawk, Rabih G. , Huynh, Thien , Gévry, Guylaine , Gentric, Jean‐Christophe , _, _, _, _, Rempel, Jeremy L , O'Kelly, Cian J , Fahed, Robert , Santos, Marlene dos, Nonent, Michel , Timsit, Serge , Desal, Hubert , Blanc, Raphaël , Eugene, François, Bras, Anthony Le , Ferré, Jean‐Christophe , Paya, Christophe, Rodriguez-Régent, Christine , Kerleroux, Basile , Touzé, Emmanuel , Dumot, Chloé , Charbonnier, Guillaume , Gory, Benjamin , Boulouis, Grégoire , Velut, Stéphane , Bibi, Richard , Troude, Lucas , Sourour, Nader Antoine , Lenck, Stéphanie , Premat, Kévin , Corre, Marine Le, Bonafé, Alain , Dargazanli, Cyril , Gascou, Grégory , Lefèvre, Pierre-Henri , Pop, Raoul , Spelle, Laurent , Chalumeau, Vanessa , Gallas, Sophie , Mihalea, Cristian , Mounayer, Charbel , Thouant, Pierre , Silva, Gisele Sampaio , Montalverne, Francisco Jose

Journal of Neurosurgery | September 9, 2022 | Volume: 138 | Issue: 4 | Pages: 891-899

10.3171/2022.7.jns22813

OBJECTIVE The Treatment of Brain Arteriovenous Malformations Study (TOBAS) is a pragmatic study that includes 2 randomized trials and registries of treated or conservatively managed patients. The authors report the results of the surgical registry. METHODS TOBAS patients are managed according to an algorithm that combines clinical judgment and randomized allocation. For patients considered for curative treatment, clinicians selected from surgery, endovascular therapy, or radiation therapy as the primary curative method, and whether observation was a reasonable alternative. When surgery was selected and observation was deemed unreasonable, the patient was not included in the randomized controlled trial but placed in the surgical registry. The primary outcome of the trial was mRS score > 2 at 10 years (at last follow-up for the current report). Secondary outcomes include angiographic results, perioperative serious adverse events, and permanent treatment-related complications leading to mRS score > 2. RESULTS From June 2014 to May 2021, 1010 patients were recruited at 30 TOBAS centers. Surgery was selected for 229/512 patients (44%) considered for curative treatment; 77 (34%) were included in the surgery versus observation randomized trial and 152 (66%) were placed in the surgical registry. Surgical registry patients had 124/152 (82%) ruptured and 28/152 (18%) unruptured arteriovenous malformations (AVMs), with the majority categorized as low-grade Spetzler-Martin grade I–II AVM (118/152 [78%]). Thirteen patients were excluded, leaving 139 patients for analysis. Embolization was performed prior to surgery in 78/139 (56%) patients. Surgical angiographic cure was obtained in 123/139 all-grade (89%, 95% CI 82%–93%) and 105/110 low-grade (95%, 95% CI 90%–98%) AVM patients. At the mean follow-up of 18.1 months, 16 patients (12%, 95% CI 7%–18%) had reached the primary safety outcome of mRS score > 2, including 11/16 who had a baseline mRS score ≥ 3 due to previous AVM rupture. Serious adverse events occurred in 29 patients (21%, 95% CI 15%–28%). Permanent treatment-related complications leading to mRS score > 2 occurred in 6/139 patients (4%, 95% CI 2%–9%), 5 (83%) of whom had complications due to preoperative embolization. CONCLUSIONS The surgical treatment of brain AVMs in the TOBAS registry was curative in 88% of patients. The participation of more patients, surgeons, and centers in randomized trials is needed to definitively establish the role of surgery in the treatment of unruptured brain AVMs. Clinical trial registration no.: NCT02098252 (ClinicalTrials.gov)