Clinical and morphological pattern of brain arteriovenous malformations (BAVMs) in a tertiary care hospital in Bangladesh.

Abstract

BackgroundWe have conducted this study to examine the clinical and morphological pattern of brain arteriovenous malformations (BAVMs) along with their treatment and short term outcome in a tertiary care hospital in Bangladesh. This retrospective chart review was carried out from the records of neuro-endovascular division at Department of Neurology, Dhaka Medical College Hospital (DMCH) from January 2010 to June 2013. A total 60 patients were evaluated. All the necessary information regarding the demographic, clinical, morphologic and treatment profile was gathered through a predesigned questionnaire. To our knowledge, we have the largest cohort of BAVM patients in Bangladesh and this is the first of this kind of study done in Bangladesh.ResultsThe mean age at diagnosis was 30.3 years with a standard deviation of ±14.3 and the majority was teenagers (30 %). Intracerebral hemorrhage was the commonest (70 %) type of presentation at diagnosis, followed by headache (50 %), altered consciousness (50 %), vomiting (40 %) and seizure (40 %). Majority of the AVMs had feeders from anterior circulation (50 %) and most of the AVMs (73.3 %) were supplied from the main feeders, whereas the rest from distal vessels. Regarding venous drainage, AVMs drained mostly either to superficial (43.3 %) or deep (40 %) venous system. AVMs frequently had larger (40 %) nidus size and a slow to medium flow (60 %), through the nidus. An eloquent AVM location was found in 50 % of the patients. Intranidal aneurysm was found in 10 % AVM and angiopathic AVM in 13.3 %. Patients were treated by endovascular embolization (31) or surgical excision (11) or conservative approach. There was one event of death, both in embolization group and surgically treated group before discharge. The patients were followed up for 1.3 ± 0.8 years. The rate of rebleed was 6.6, 30 and 60 % during follow up in endovascular, surgical and conservatively treated group. Though five patients in conservative group died during this time, no deaths reported in intervention group (endovascular or surgery).ConclusionIntracerebral hemorrhages, headache, altered consciousness and seizure are common clinical presentations of AVM at diagnosis. The remarkable morphologic features are larger AVM size at eloquent location, medium to slow flow with frequent feeders from main vessels of anterior circulation and drainage to superficial venous systems. Endovascular embolization or surgical excision of AVM are relatively safe and effective and provides better short term outcome than conservative approach.