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[Conservative treatment of cerebral arteriovenous malformations. Follow-up study of 31 cases]
T Majewski1, W Liebert, S Nowak
1Katedry i Kliniki Neurochirurgii Akademii Medycznej w Poznaniu im.
Abstract:
The clinical course of 31 patients with conservatively treated intracranial arteriovenous malformations (AVM's) was followed-up. The average follow-up period was 8.2 years, 75% of patients were followed up for more than 5 years. The initial symptom was intracranial bleeding in 21 patients (68%), seizure in 5 (16%), neurological deficit in 2 (6.5%), headache in 2 (6.5%) and intracranial hypertension in 1 (3%). The prognosis was more favourable for patients presenting with seizures than for patients presenting with haemorrhage. Patients in the haemorrhage group had 29% incidence of haemorrhage causing 14% mortality in this group. Of the 31 patient's 20 (64.5%) had a good clinical outcome, 4 (13%) had a fair outcome and 2 (6.5%) poor, 5 patients died, with one not due to AVM. There was no correlation between pregnancy and bleeding.
Insights
Conservative management of intracranial arteriovenous malformations (AVMs) shows a favorable prognosis for patients with seizures. However, those with initial hemorrhage face higher risks of re-bleeding and mortality.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Neurology
Context:
- Intracranial arteriovenous malformations (AVMs) are complex vascular lesions.
- Conservative management is a treatment option for select AVM cases.
- Long-term clinical outcomes of conservatively managed AVMs require detailed investigation.
Purpose:
- To evaluate the long-term clinical course and outcomes of patients with intracranial AVMs treated conservatively.
- To identify factors influencing prognosis in conservatively managed AVM patients.
Summary:
- This study followed 31 patients with conservatively treated intracranial AVMs for an average of 8.2 years.
- Intracranial bleeding was the initial symptom in 68% of patients, while seizures presented in 16%.
- Prognosis was better for patients presenting with seizures compared to those with hemorrhage, who had a 29% re-bleeding rate and 14% mortality.
- Overall, 64.5% of patients achieved a good clinical outcome, with no correlation found between pregnancy and bleeding.
Impact:
- Conservative management can lead to good clinical outcomes in a significant portion of AVM patients.
- Initial presentation (hemorrhage vs. seizure) is a critical prognostic factor.
- Findings inform clinical decision-making regarding AVM treatment strategies.