{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:19:18Z","timestamp":1787761158858,"version":"build-2784847793"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Both early surgery and delayed surgery of ruptured arteriovenous malformation (AVM) with intracerebral hemorrhages have their own advantages and disadvantages. Due to lack of large case\u2013control studies, timing of surgery for ruptured AVM excision is still a controversial topic. So, we did a systemic review and meta-analysis, including our experience of early surgery, to see which surgical strategy has a favorable outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>We systematically searched several databases and journals to screen eligible studies. After synthesizing data, results of individual studies of early and delayed surgery were calculated as the effect size (ES) and 95% confident intervals (CIs), and the pooled ES was calculated using random-effects model. Heterogeneity and publication bias were assessed for the individual outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of nine published studies, one oral presentation, and our unpublished study were included in the analysis. Delayed surgery has better results than early surgery in terms of complete excision rate (delayed ES, 1.00; 95% CI, 0.97 1.00 vs. early ES, 0.96; 95% CI, 0.91 0.99), good functional outcome (delayed ES, 0.94; 95% CI, 0.86 0.99 vs. early ES, 0.68; 95% CI, 0.51 0.84), and mortality (delayed ES, 0.00; 95% CI, 0.00 0.01 vs. early ES, 0.04; 95% CI, 0.01 0.10). Heterogeneity was significant in the results of early surgery group, and no publication bias was found in the meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Delayed surgery is superior to early surgery in achieving higher complete excision rate, good functional outcome, and reducing mortality. However, larger comparative studies are needed for subgroup analysis and for reducing the impact of various confounding factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/0028-3886.364074","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T11:28:36Z","timestamp":1671190116000},"page":"2343-2349","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Timing of Surgery for Ruptured Arteriovenous Malformations with Intracerebral Hemorrhage"],"prefix":"10.4103","volume":"70","author":[{"given":"Varun","family":"Aggarwal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema","family":"Rohilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishwar","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vardan","family":"Pandey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopal","family":"Krishna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-3-20240907","doi-asserted-by":"crossref","first-page":"749","DOI":"10.4103\/0028-3886.59471","article-title":"Surgical interventions in intracranial arteriovenous malformations: Indications and outcome analysis in a changing scenario","volume":"57","author":"Thapa","year":"2009","journal-title":"Neurol India"},{"key":"R4-3-20240907","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1159\/000437121","article-title":"Surgical strategies for acutely ruptured arteriovenous malformations","volume":"37","author":"Martinez","year":"2015","journal-title":"Front Neurol Neurosci"},{"key":"R5-3-20240907","doi-asserted-by":"crossref","first-page":"999","DOI":"10.3171\/2017.1.JNS16745","article-title":"Delayed treatment of ruptured arteriovenous malformations: Is it ok to wait?","volume":"128","author":"Beecher","year":"2018","journal-title":"J Neurosurg"},{"key":"R6-3-20240907","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3171\/jns.1984.60.1.0014","article-title":"Cerebral arteriovenous malformations. Indications for and results of surgery, and role of intravascular techniques","volume":"60","author":"Lussenhop","year":"1984","journal-title":"J Neurosurg"},{"key":"R7-3-20240907","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.surneu.2009.03.035","article-title":"Acute surgical removal of low-grade (Spetzler- Martin I-II) bleeding arteriovenous malformations","volume":"72","author":"Pavesi","year":"2009","journal-title":"Surg Neurol"},{"key":"R8-3-20240907","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"R10-3-20240907","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/0197-2456(86)90034-6","article-title":"Analysis of data from multiclinic trials","volume":"7","author":"Fleiss","year":"1986","journal-title":"Control Clin Trials"},{"key":"R11-3-20240907","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1214\/ss\/1177011363","article-title":"An approach to assessing publication bias prior to performing a meta-analysis","volume":"7","author":"Dear","year":"1992","journal-title":"Stat Sci"},{"key":"R12-3-20240907","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.2307\/2533446","article-title":"Operating characteristics of a rank correlation test for publication bias","volume":"50","author":"Begg","year":"1994","journal-title":"Biometrics"},{"key":"R13-3-20240907","first-page":"26","article-title":"Acute operation on arteriovenous malformation with hematomas- report on six cases","volume":"35","author":"Steudel","year":"1992","journal-title":"Neurochirurgia"},{"key":"R14-3-20240907","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/BF02389310","article-title":"Early surgical treatment of intracerebral hemorrhages caused by AVM: Our experience in 10 cases","volume":"21","author":"Puzzilli","year":"1998","journal-title":"Neurosurg Rev"},{"key":"R15-3-20240907","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/3-211-27911-3_17","article-title":"Early surgery for ruptured cerebral arteriovenous malformations","volume":"94","author":"Kuhmonen","year":"2005","journal-title":"Acta Neurochir Suppl"},{"key":"R16-3-20240907","doi-asserted-by":"crossref","first-page":"199","DOI":"10.4103\/0028-3886.79138","article-title":"Computed tomography angiography based emergency microsurgery for massive intracranial hematoma arising from arteriovenous malformations","volume":"59","author":"Tan","year":"2011","journal-title":"Neurol India"},{"key":"R17-3-20240907","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1093\/neuros\/nyx003","article-title":"Clinical experience and results of microsurgical resection of arteriovenous malformation in the presence of space-occupying intracerebral hematoma","volume":"81","author":"Barone","year":"2017","journal-title":"Neurosurgery"},{"key":"R18-3-20240907","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.neuchi.2016.10.010","article-title":"Grade 1 Spetzler and Martin cerebral ruptured arteriovenous malformations treated by microsurgery: Poor functional outcome is related to injury from hemorrhage","volume":"63","author":"Aboukais","year":"2017","journal-title":"Neurochirurgie"},{"key":"R19-3-20240907","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1007\/s00381-020-04501-0","article-title":"Surgical strategies for management of pediatric arteriovenous malformation rupture: The role of initial decompressive craniectomy","volume":"36","author":"LoPresti","year":"2020","journal-title":"Childs Nerv Syst"},{"key":"R20-3-20240907","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1097\/00006123-199809000-00338","article-title":"Prospective analysis of delayed surgery in the treatment of 41 patients presenting with AVM hemorrhage","volume":"43","author":"Norris","year":"1998","journal-title":"Neurosurgery"},{"key":"R21-3-20240907","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1007\/s10143-019-01210-4","article-title":"Long-term outcomes and prognostic predictors of 111 pediatric hemorrhagic cerebral arteriovenous malformations after microsurgical resection: A single-centre experience","volume":"44","author":"Deng","year":"2020","journal-title":"Neurosurg Rev"},{"key":"R22-3-20240907","doi-asserted-by":"crossref","first-page":"444","DOI":"10.23736\/S0390-5616.18.04370-9","article-title":"Cohort studies, trials and tribulations: Systematic review and an evidence- based approach to AVM treatment","volume":"62","author":"Simons","year":"2018","journal-title":"J Neurosurg Sci"},{"key":"R23-3-20240907","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.3171\/2019.1.JNS182156","article-title":"The future of open vascular neurosurgery: Perspectives on cavernous malformations, AVMs, and bypasses for complex aneurysm","volume":"130","author":"Lawton","year":"2019","journal-title":"J Neurosurg"},{"key":"R24-3-20240907","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s11883-012-0257-9","article-title":"Management of ruptured brain arteriovenous malformations","volume":"14","author":"Zacharia","year":"2012","journal-title":"Curr Atheroscler Rep"},{"key":"R25-3-20240907","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1161\/01.STR.32.6.1458","article-title":"AHA Scientific Statement: Recommendations for the management of intracranial arteriovenous malformations: A statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association","volume":"32","author":"Ogilvy","year":"2001","journal-title":"Stroke"},{"key":"R26-3-20240907","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1227\/00006123-198709000-00006","article-title":"Staged treatment of arteriovenous malformations of the brain","volume":"21","author":"Andrews","year":"1987","journal-title":"Neurosurgery"},{"key":"R27-3-20240907","first-page":"148","article-title":"Urgent removal of ruptured cerebral arteriovenous malformations in children","volume":"149","author":"Benifla","year":"2010","journal-title":"Harefuah"},{"key":"R28-3-20240907","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1007\/s00701-017-3315-9","article-title":"Timing of surgery for ruptured supratentorial arteriovenous malformations","volume":"159","author":"Hafez","year":"2017","journal-title":"Acta Neurochir"},{"key":"R29-3-20240907","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0720-048X(03)00091-3","article-title":"Management of patients with brain arteriovenous malformations","volume":"46","author":"Soderman","year":"2003","journal-title":"Eur J Radiol"},{"key":"R30-3-20240907","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/978-3-211-99373-6_11","article-title":"Present state of microneurosurgery of cerebral arteriovenous malformations","volume":"107","author":"Hernesniemi","year":"2010","journal-title":"Acta Neurochir Suppl"},{"key":"R31-3-20240907","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1227\/01.NEU.0000153924.67360.EA","article-title":"Effect of presenting hemorrhage on outcome after microsurgical resection of brain arteriovenous malformations","volume":"56","author":"Lawton","year":"2005","journal-title":"Neurosurgery"},{"key":"R32-3-20240907","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1001\/jama.2011.1632","article-title":"Treatment of brain arteriovenous malformations: A systematic review and meta-analysis","volume":"306","author":"Beijnum","year":"2011","journal-title":"JAMA"}],"container-title":["Neurology India"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/0028-3886.364074","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:25:02Z","timestamp":1787757902000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/0028-3886.364074"}},"subtitle":["A Systematic Review and Meta-Analysis"],"short-title":[],"issued":{"date-parts":[[2022,11]]},"references-count":29,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/0028-3886.364074","relation":{},"ISSN":["0028-3886"],"issn-type":[{"value":"0028-3886","type":"print"}],"subject":[],"published":{"date-parts":[[2022,11]]}}}