Osler-Weber-Rendu syndrome treatment [Neurosurgery Wiki]

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====== Osler-Weber-Rendu syndrome treatment ======

{{ ::osler-weber-rendu_syndrome.jpg?200|}}

[[Osler-Weber-Rendu syndrome]] treatment focuses on reducing [[bleeding]] from [[blood vessel]] lesions, and sometimes surgery or other targeted [[intervention]]s to remove [[arteriovenous malformation]]s in organs. Chronic bleeding often requires [[iron]] supplements and sometimes [[blood transfusion]]s. 

Surgery is indicated mainly for the evacuation of [[hematoma]] or diagnosis, especially when favorably located. Also, consider surgery for recurrent hemorrhages (rupture has been reported even after normal angiography) or medically intractable seizures. [[Stereotactic radiosurgery]] has not had a satisfactorily high enough benefit to risk ratio to justify its use
((Lindquist C, Guo W-Y, Kerlsson B, Steiner L. Radiosurgery for Venous Angiomas. J Neurosurg. 1993; 78:531–536)).
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The risk of treatment of brain [[AVM]]s in patients with Osler-Weber-Rendu syndrome is quite low for appropriately selected patients with treatment individualized to [[radiosurgery]], [[microsurgery]], or a combination of [[embolization]] and microsurgery
((Woodall MN, Nakaji P, Spetzler RF. Benefits of Treating Arteriovenous
Malformations in Hereditary Hemorrhagic Telangiectasia: A Retrospective Analysis 
of 14 Patients. World Neurosurg X. 2019 Mar 9;3:100029. doi:
10.1016/j.wnsx.2019.100029. eCollection 2019 Jul. PubMed PMID: 31225521; PubMed
Central PMCID: PMC6584483.
)).
----
Currently, conventional [[heparin]] and [[warfarin]] remain first choice [[anticoagulant]]s. If newer anticoagulants are considered, although study numbers are small, at this stage [[Apixaban]] appears to be associated with lesser bleeding risk than [[Rivaroxaban]]
((Shovlin CL, Millar CM, Droege F, Kjeldsen A, Manfredi G, Suppressa P, Ugolini 
S, Coote N, Fialla AD, Geisthoff U, Lenato GM, Mager HJ, Pagella F, Post MC,
Sabbà C, Sure U, Torring PM, Dupuis-Girod S, Buscarini E; VASCERN-HHT. Safety of 
direct oral anticoagulants in patients with hereditary hemorrhagic
telangiectasia. Orphanet J Rare Dis. 2019 Aug 28;14(1):210. doi:
10.1186/s13023-019-1179-1. PubMed PMID: 31462308; PubMed Central PMCID:
PMC6714298.
)).

===== References =====