American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2017, 5(4), 101-103
DOI: 10.12691/ajmcr-5-4-6
Open AccessArticle

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

Zahra Janamiri1, Yasaman Arjmand1 and Pooya Torkian1,

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

Pub. Date: May 22, 2017

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


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.

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

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[1]  Kim, H., Su, H., Weinsheimer, S., Pawlikowska, L., Young, W.L., “Brain arteriovenous malformation pathogenesis: a response-to-injury paradigm,” Acta Neurochir Suppl, 111:83-92. 2011.
[2]  Al-Shahi, R., Fang, J.S., Lewis, S.C., Warlow, C.P., “Prevalence of adults with brain arteriovenous malformations: a community based study in Scotland using capture-recapture analysis,” Journal of Neurology, Neurosurgery & Psychiatry, 73(5). 547-51. 2002.
[3]  Guo, P., Zhao, J.Z., “Clinical characteristics and surgical outcomes of 3094 patients with cerebral arteriovenous malformation,” Zhonghua yi xue za zhi, 91(39). 2740-3. 2011.
[4]  Gabriel, R.A., Kim, H., Sidney, S., McCulloch, C.E., Singh, V., Johnston, S.C., Ko, N.U., Achrol, A.S., Zaroff, J.G., Young, W.L., “Ten-year detection rate of brain arteriovenous malformations in a large, multiethnic, defined population,” Stroke, 41(1). 21-6. 2010.
[5]  van Beijnum, J., van der Worp, H.B., Buis, D.R., Salman, R.A., Kappelle, L.J., Rinkel, G.J., van der Sprenkel, J.W., Vandertop, W.P., Algra, A., Klijn, C.J., “Treatment of brain arteriovenous malformations: a systematic review and meta-analysis,” Jama, 306(18). 2011-19. 2011.
[6]  Ogilvy, C.S., Stieg, P.E., Awad, I., Brown, R.D., Kondziolka, D., Rosenwasser, R., Young, W.L., Hademenos, G., “Recommendations for the management of intracranial arteriovenous malformations,” Stroke, 32(6). 1458-71. 2001.
[7]  Fine, A.D., Beauregard, C.L., Day, A.L., “20 Arteriovenous Malformations of the Cerebellar Vermis and Hemispheres,” Intracranial Arteriovenous Malformations, 285. 2006.
[8]  Berman, M.F., Sciacca, R.R., Pile-Spellman, J., Stapf, C., Connolly Jr, E.S., Mohr, J.P., Young, W.L., “The epidemiology of brain arteriovenous malformations,” Neurosurgery, 47(2). 389-97. 2000.
[9]  Kim, H., Pawlikowska, L., Weinsheimer, S., Kwok, P.Y., Zaroff, J.G., McCulloch, C.E., Young, W.L., “Genome-wide association study of intracranial hemorrhage in brain arteriovenous malformation (BAVM) patients,” Stroke, 41(e11). P37. 2010.
[10]  Ondra, S.L., Troupp, H., George, E.D., Schwab, K., “The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment,” Journal of neurosurgery, 73(3). 387-91. 1990.
[11]  Davies, J.M., Yanamadala, V., Lawton, M.T., “Comparative effectiveness of treatments for cerebral arteriovenous malformations: trends in nationwide outcomes from 2000 to 2009,” Neurosurgical focus, 33(1). E11. 2012.
[12]  Söderman, M., Andersson, T., Karlsson, B., Wallace, M.C., Edner, G., “Management of patients with brain arteriovenous malformations,” European journal of radiology, 46(3). 195-205. 2003.
[13]  Pandey, P., Marks, M.P., Harraher, C.D., Westbroek, E.M., Chang, S.D., Do, H.M., Levy, R.P., Dodd, R.L., Steinberg, G.K., “Multimodality management of Spetzler-Martin Grade III arteriovenous malformations: Clinical article,” Journal of neurosurgery, 116(6). 1279-88. 2012.
[14]  Wedderburn, C.J., van Beijnum, J., Bhattacharya, J.J., Counsell, C.E., Papanastassiou, V., Ritchie, V., Roberts, R.C., Sellar, R.J., Warlow, C.P., Salman, R.A., “Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study,” The Lancet Neurology, 7(3). 223-30. 2008.
[15]  Brown Jr, R.D., Wiebers, D.O., Torner, J.C., O'Fallon, W.M., “Frequency of intracranial hemorrhage as a presenting symptom and subtype analysis: a population-based study of intracranial vascular malformations in Olmsted County, Minnesota,” Journal of neurosurgery, 85(1). 29-32. 1996.
[16]  Van Beijnum, J., Bhattacharya, J.J., Counsell, C.E., Papanastassiou, V., Ritchie, V., Roberts, R.C., Sellar, R.J., Warlow, C., Salman, R.A., “Patterns of Brain Arteriovenous Malformation Treatment,” Stroke, 39(12). 3216-21. 2008.
[17]  Muñoz, F., Clavel, P., Molet, J., Castaño, C., De Teresa, S., Solivera, J., De Quintana, C., Tresserras, P., Rodríguez, R., Bartumeus, F., “Current management of arteriovenous malformations. Retrospective study of 31 cases and literature review,” Neurocirugia (Asturias, Spain), 18(5). 394-404. 2007.
[18]  Altay, T., “Management of Arteriovenous Malformations Related to Spetzler–Martin Grading System,” Journal of Neurological Surgery Part A: Central European Neurosurgery, 73(05). 307-19. 2012.
[19]  Gross, B.A., Du, R., “Surgical and radiosurgical results of the treatment of cerebral arteriovenous malformations,” Journal of Clinical Neuroscience, 19(7). 1001-4. 2012.
[20]  Nikouei, A., Seddighi, A., Seddighi, A.S., “The Results of Image Guided Surgery Using Neuronavigation in Resection of Cerebral Gliomas in Eloquent Cortical Areas,” Archives of Physical Medicine and Rehabilitation, 97(10). e69-70. 2016.
[21]  Yang, S.Y., Kim, D.G., Chung, H.T., Paek, S.H., “Radiosurgery for unruptured cerebral arteriovenous malformations Long-term seizure outcome,” Neurology, 78(17). 1292-8. 2012.