Management of Intracranial Arteriovenous Malformation

Abstract

Thirty-six patients with intracranial arteriovenous malformations were studied. These patients were the cases of AVM brought to clinical attention during a period of two years. Every case underwent accurate history taking and thorough neurological assessment. CT scan, MRI, and four vessels angiography were done for each case. A neurosurgeon, an interventional neuroradiologist and in some cases a radiotherapist reviewed this information. The decision was taken for the appropriate modality of management. These modalities included embolisation, surgery, radiosurgery or a combination of them.

Males and females were equally affected and the age incidence ranged between 12 and 57 years with an average of 32.1. Hemorrhage was the most common presentation. This was followed by seizures, headache and neurological deficits. In contradiction to a previous impression, Small AVMs did not have a greater tendency to bleeding than large AVMs. The average age at which AVMs was discovered is younger when compared to previous reports (32.1 compared to 40 years). This can be explained by the more frequent use of neuroradiological investigations in the recent years. Spetzler and Martin grading system was applied to this series. Accordingly, the present series was categorized as nine cases belonging to grade one, fourteen cases to grade two, eight to grade three and five to grade four.