Angiographic and Clinical Assessment of Patients with Cerebral Arterio-Venous Malformations Treated with Microsurgery and Angioembolization

Zahra Janamiri¹, Yasaman Arjmand¹ and Pooya Torkian^1,

¹Department of Radiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Cite this paper

Zahra Janamiri, Yasaman Arjmand and Pooya Torkian. Angiographic and Clinical Assessment of Patients with Cerebral Arterio-Venous Malformations Treated with Microsurgery and Angioembolization. American Journal of Medical Case Reports. 2017; 5(4):101-103. doi: 10.12691/AJMCR-5-4-6

Abstract

Introuction: Brain Arteriovenous malformations (AVMs) are the leading cause of intracerebral hemorrhage in the young population. We set out to determine angiographic features of AVMs in pre-operative setting as well as angiographic and neurological and clinical assessment of these AVMs after treatment with either microsurgical approach or angio-embolization. Materials and Methods: From February 2011 to January 2016, 25 patients with cerebral AVMs were admitted to Shohada Tajrish Hospital. Patients underwent angiographic evaluation for AVM grading based on Spetzler Martin grading system. Also, patient’s neurological status was recorded. Based on Spetzler Martin score and AVM size, patients underwent either microsurgical approach or angio-embolization. Post-operatively, early and long-term neurological examination was performed and obliteration rate was assessed by post-operative imaging study. Results: There were 18 male and 7 female patients with mean age of 42.2 years who presented with cerebral hemorrhage followed by isolated new-onset seizure, progressive new focal neurological deficit and severe new-onset headache in decreasing manner. Seizure was significantly higher in patients with unruptured AVMs (P value <0.01). Angiographic study based on Spetzler-Martin grading system showed that most of the patients had grade 3 (32%), followed by grade 4 (28%), grade 2 (28%), grade 5 (8%) and grade 1 (4%). Most AVMs were eloquent with superficial drainage and small sized. Based on AVM size, trend for operation type in small and medium sized AVMs was microsurgical approach followed by angio-embolization. On the other hand, most patients with large-sized AVMs underwent angio-embolization followed by microsurgical approach. Early post-operative examination revealed more new neurological deficit in angio-embolization than microsurgery treated patients (P value <0.05). Improvement in neurological status was observed in microsurgery treated cases compared to angio-embolization (P value <0.05). Long-term follow up showed similar promising results in patients treated with microsurgery which was statistically significant (P value <0.05). Post-operative imaging study demonstrates complete obliteration in 12 patients out of 15 patients (80%) who underwent microsurgical approach. Complete obliteration was observed in 4 cases out of 10 patients (40%) who were treated with angio-embolization. (P value < 0.05). Conclusion: Although results of this study showed better results with microsurgical approach, choosing best treatment option for patients suffering from symptomatic AVMs depends on imaging studies, pre-operative grading and individual-based selection.

Keywords

arterio-venous malformation, angiography, spetzler-marting grading system, microsurgery, angio-embolization

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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