Occipital arteriovenous malformations: visual disturbances and presentation

Area of Science:

• Neurology
• Neurosurgery
• Ophthalmology

Background:

• Occipital arteriovenous malformations (AVMs) present with diverse symptoms including visual disturbances and headaches.
• Early diagnosis and treatment of occipital AVMs are crucial to prevent hemorrhages, visual field loss, and other neurological deficits.

Purpose of the Study:

• To investigate the presentation and treatment outcomes of patients with occipital AVMs.
• To analyze the relationship between AVM characteristics and visual field loss.
• To evaluate the efficacy and complications of various treatment modalities for occipital AVMs.

Main Methods:

• Retrospective review of 70 patients with occipital AVMs treated at New York University Medical Center.
• Analysis of patient symptoms, visual field assessments, and treatment modalities (embolization, surgery, radiosurgery).
• Comparison of outcomes between different treatment groups and assessment of factors influencing visual field loss.

Main Results:

• The majority of patients (68/70) presented with symptoms such as visual disturbances (39), headache (39), seizures (20), and hemorrhage (26).
• Visual field loss was more frequent and severe in patients who experienced hemorrhage.
• Surgical excision resulted in AVM elimination in 19/20 patients, significantly higher than embolization alone (4/27). However, treatment, particularly surgery, could lead to new or worsened visual field loss in some patients.

Conclusions:

• Occipital AVMs are distinct from migraine, despite some overlapping symptoms.
• Spontaneous visual field improvement can occur after intracerebral hemorrhage.
• Surgical treatment, especially excision, is effective for AVM elimination but carries a risk of visual field deficits.