Clinical series of intracranial arteriovenous malformations [AVMs]: prospective analysis of 25 consecutive cases

ABSTRACT

The purpose of this study was to assess demographic, clinical, and morphological characteristics as well as treatment and outcome of patients with brain arteriovenous malformations [AVMs]. Twenty five patients with brain arteriovenous malformations [AVMs] had been studied and analyzed over a two-year period [April 2004-Marsh 2006] and assessed regarding demographic characteristics, morphological characteristics of AVMs according to the Spetzler-Martin grading system, clinical characteristics [type of presentations], as well as the mode of therapy [surgery, endovascular treatment and/or radiosurgical treatment] and the outcome angiographically in term of nidus occlusion and clinically by using the Glasgow outcome score [GOS]. Twenty five consecutive patients with intracranial AVMs were enrolled in this study. Their ages ranged between the second and the sixth decades with maximum incidence during the fourth decade [40%]. They were 14 [56%] males and 11 [44%] females. AVMs were more common in the supratentorial region [84%] than infratentorial one [16%] and the majority of patients were in grade two [11 patients; 44%] and grade one [10 patients; 40%]. Clinically, the most common presentation was haemorrhage [13 patients; 52%] followed by seizure [7 patients; 28%]. The combination therapy was done in 18 [72%] patients where embolization plus radiosurgery were used in 13 [72%] patients while embolization plus surgery was used in 5 [28%] patients. Mortality rate was zero. Four [16%] patients developed complications related to management. Intracranial arteriovenous malformations [AVMs] can cause stroke when they rupture. Epidemiological and imaging research has found that about 50% of patients with AVMs present with haemorrhage, and the other 50% either present with non-focal symptoms, such as headache, seizure, or focal neurological deficit, or have no symptoms and the lesion is found during unrelated investigations. The aim of treatment is total obliteration of the malformation, because the general belief is that any residual AVMs might result in haemorrhage. Obliteration might be achieved completely and in most cases by multimodal therapy rather than by a single-mode treatment. Thus, a multidisciplinary approach to any detected AVMs is recommended. Since the risk of rebleeding is high, and it is the main cause of disability in patients with AVMs. Early treatment is recommended for those who have bled, and such treatment should begin as soon as is feasible