A clinical study of intracranial AVMs with reference to their enlargement and regression--a follow-up study with angiography and CT scan (author's transl)

Abstract

From March 1960 to April 1975, 31 cases with arteriovenous malformation were treated without radical operation due to various reasons. Of these cases, it was possible to carry out follow-up study by cerebral angiography in 15 for a maximum of 15 years, with the mean period being 6.6 years. Four of the 15 received radiation therapy and 3 had exploratory craniotomy only, while the remaining were treated medically. The ages when angiographic changes were first noted ranged from 22 to 49, with the mean being 35.5 years. Twelve of the 15 cases were males. The initial symptom most frequently noted was subarachnoid hemorrhage in 10 cases, followed by convulsion in 4, and 1 with hemiparesis and speech disturbance due to intracerebral hematoma. At the time of the second angiography 7 cases were asymptomatic, and all the other 8 cases with hemiparesis, hemianopsea or aphasia were able to make their own living. The size of AVM increased in 5(33.3%), decreased in 2(13.3%), totally regressed in 2(13.3%) and unchanged in 6(40%). 4 cases of the 5 with increase in size affected the parietal and temporal regions, where it was considered by some authors increase in size readily occurs. The main feeders in the 6 cases in whom the size of AVM remained unchanged were arteries incapable of providing a large amount of blood, such as the thalamoperforating artery, anterior choroidal artery and branch of the posterior cerebral artery, with the exception of 1 case in whom the feeder was the middle cerebral artery. No changes could be observed on the feeders or drainers per se of these cases. Total regression was noted in 2 cases, in one of whom it was so-called spontaneous total regression and in the other it occurred after radiation therapy. It is difficult to grasp the detailed morphology of AVM even with newly developed computed tomography scanner, but the apparatus is useful in observing the changes in AVM and its surrounding tissues, and thus is necessary for follow-up studies.