Clinical characteristics and surgical outcomes of 3094 patients with cerebral arteriovenous malformation

Abstract

To retrospectively analyze the clinical characteristics and surgical outcomes of 3094 patients with cerebral arteriovenous malformation (AVM) over a course of 53 years. The clinical data of 3094 consecutive AVM patients from July 1956 to April 2009 were collected and analyzed. The parameters included age (at diagnosis), gender, initial onset, Spetzler-Martin grade, relationship of lesion volume and blood, AVM with aneurysm, AVM with varices, surgical outcomes and mortality. Cerebral AVMs were more commonly diagnosed at a mean age of 27 ± 13 years old (range: 12 - 38). Hemorrhage (n = 1617, 52.26%), headache (n = 550, 17.78%) and seizure (n = 397, 12.83%) were the first three common presentations. A total of 1486 patients were estimated by Spetzler-Martin grading system. And the percentage of grades 2 - 4 patients was highly than that of other levels. The smaller the lesion volume, the greater risk of intracranial hemorrhage. Varices were found in 26 (0.84%) of 3094 AVM patients. And 12 (46.15%) patients with varices had a hemorrhage at presentation. Aneurysm was found in 66 (2.13%) of 3094 AVM patients. And 38 (57.58%) patients with varices had a hemorrhage at presentation. Among them, 2013 patients received microsurgery treatment. The outcomes were recovery (83.51%), excellence (12.42%), no change (0.60%), deterioration (0.30%) and death (3.18%). The surgical mortality of the patients with a hemorrhage at presentation was 5.19%. The first presentation of AVM is commonly apparent at a young age. And intracranial hemorrhage occurs often at dominant positions. AVM is one of the important reasons for spontaneous intracranial hemorrhage in youth. And the risk of hemorrhage is present for a patient's whole life. Microsurgery treatment can remove the lesion and eliminate the risk of hemorrhage immediately. With the applications of neurosurgery, navigation, ultrasound and intraoperative fluorescence angiography, the surgical treatment of AVM becomes safer and more reliable.