Fifty-three patients with arteriovenous malformation (AVM) were studied. The mean age at the time of diagnosis was 32.5±11.5 years (range 3 to 56 years); the sex ratio was male 1.9:1 female. The most commmon clinical presentation was intracranial hemorrhage, followed by focal neurological signs, headache, epilepsy, and acute deep coma. Fourty-three (82%) out of the total number of AVM were supratentorial and had the following distribution: 10 temporal lobe, 9 pariental lobe, 6 frontal lobe, 3 occipital lobe, 3 frontotemporal, 4 corpus callosum/pericalosal, 1 temporo-occipital, 1 temporoparieto-occipital, 6 deep-located (3 thalamic, 3 basal ganglia). Spetzler-Martin grade II was seen in 17 cases (32%), grade III in 21 cases (39%), and grade IV in 10 cases (19%). AVM-associated aneurysms were detected in 3 patients (5.6%). All three cases were middle artery aneurysms ipsilateral to AVM. Twelve (32%) out of 37 operated patients were submitted to embolization prior to surgery. AVM was totally removed in all cases except one. Embolization without posterior surgery was used in 11 patients; in 3 of them, embolization was partial. Two patients were neither embolized nor operated on. Three patients were submitted to radiosurgery because they were poor candidates to embolization and/or surgery. Mortality rate was 1.8%. All patients returned to their normal life function after a period of recovery. Associated or isolated therapies should be individualized to each patient with AVM and is likely to provide results better than the expected outcome without any treatment.
arteriovenous malformation; intracranial hemorrhage; neurosurgery; embolization; radiosurgery
