Angioarchitecture and clinical presentation of brain arteriovenous malformations

Abstract

-The purpose of this study was to correlate the angioarchitecture of brain arteriovenous malformations (AVM) with their clinical presentation. A total of 170 patients with AVM 78 males and 92 females, were studied. Univariate and multivariate analyses were conducted in order to test the associations between morphological features and clinical presentation. The most frequent clinical presentations at diagnosis were hemorrhage in 89 (52%) patients, headache in 79 (46%), focal neurological deficit in 54 (32%), and seizure in 52 (31%). According to the Spetzler-Martin classification, grade I was found in 15 patients, II in 49, III in 55, IV in 41, and grade V in 10 patients. AVM with small nidus size, single feeding artery and single draining vein were associated with hemorrhage. Hemorrhage was positively associated with Spetzler-Martin grade I and negatively with grade V. The association between seizure and large nidus size was positive, however negative with small nidus size.Key wordS: brain arteriovenous malformations, angioarchitectural features, clinical presentation. Angioarquitetura e apresentação clínica de malformações arteriovenosas encefálicasResumo -o objetivo deste estudo foi correlacionar a angioarquitetura de malformações arteriovenosas encefálicas (MAV) com sua apresentação clínica. Foram estudados 170 pacientes portadores de MAV, sendo 78 do sexo feminino e 92 do masculino. Análises univariada e multivariada foram efetuadas para testar associações entre características morfológicas e quadro clínico. As principais formas de apresentação clínica no momento do diagnóstico incluíram hemorragia em 89 (52%) pacientes, cefaléia em 79 (46%), déficit focal em 54 (32%) e convulsão em 52 (31%). de acordo com a classificação de Spetzler e Martin, 15 pacientes tinham MAV grau I, 49 grau II, 55 grau III, 41 grau IV, e 10 grau V. MAV com nidus de tamanho pequeno, aferência e eferência únicas foram associados à hemorragia. Hemorragia foi positivamente associada com grau I e negativamente com grau V. A associação entre convulsão e nidus de tamanho grande foi positiva, porém negativa com nidus de tamanho pequeno.PAlAVrAS-cHAVe: malformações arteriovenosas encefálicas, angioarquitetura, apresentação clínica. of AVMs remains incompletely elucidated and its treatment is still a challenge to neurosurgeons. The purpose of this study was to morphologically characterize a series of brain arteriovenous malformations, trying to establish a correlation with their clinical presentation. METHODone hundred and seventy patients with brain AVMs, admitted at the Vascular and endovascular Neurosurgery Unit of Hospital de Base at São José do rio Preto, São Paulo, Brazil, were studied between January, 2001, and January, 2007. Seventy-eight (46%) were male and 92 (54%) female, and age ranged from 1 to 77 years (34.1±15 years) at presentation.This study was approved by the research ethics committee of the São José do rio Preto Medical School (FAMerP).other types of vascular malformations such as dural fistula, carotid-cavernous ...

Angioarchitecture of Brain AVM Determines the Presentation with Seizures: Proposed Scoring System

“…Only a few articles have exclusively studied the angioarchitectural characteristics of BAVMs associated with clinical presentation of seizures. 3,18 Our experience showed that certain angioarchitectural characteristics are more often associated with seizure presentation. These include cortical location; features indicative of high flow such as the presence of a fistulous component in the nidus and perinidal angiogenesis; and features indicative of venous congestion, such as a long pial course of the draining vein, pseudophlebitic pattern, and venous outflow stenosis.…”

“…Other studies have shown that large and medium nidus sizes (3-6 cm and Ͼ6 cm, respectively) were positively correlated with seizure occurrence, whereas small nidus size (Ͻ3 cm) was negatively correlated with presentation with seizures. 18 A large BAVM may be more likely to present with seizures because the overall "sump effect" of the BAVM may be more prominent, compared with a small BAVM. Seizure occurrence may also be related to the larger volume of tissue in the circumferential vicinity of the BAVM, with a higher likelihood of affecting a potentially ictogenic zone, or it may be due to a more widespread hypoxemia.…”

“…[13][14][15][16][17] There are only a few studies that have examined the association between individual angioarchitectural characteristics of the BAVM and seizure presentation. 3,18 Turjman et al, 2 in their study of 100 consecutive patients with seizures, and Santos et al, 18 in their study of 170 patients with BAVM, found multiple morphologic features of BAVM associated with seizures. However, these studies lacked a thorough analysis of the hemodynamic characteristics of the BAVM.…”

“…Frontal and parietal locations as well as feeding arteries from the MCA have been shown to be positively correlated with seizure occurrence, while the correlation between the occipital and cerebellar regions and deep location have been shown to be negative. 5,6,18 Arterial Flow. Factors related to high flow such as dilation of the feeding artery and a fistulous component in the nidus can give rise to relative arterial functional steal in the region of the nidus.…”

Endovascular Embolization of Cerebral Arteriovenous Malformations

“…However, this pattern is gradually changing. Increasing availability of noninvasive imaging methods, mainly MRI, have led to more and more frequent detection of unruptured and even incidental AVMs (4) . Cerebral arteriovenous malformations are amenable to various treatment modalities which include the following either individually or in combination: surgical removal (resection), radiosurgery and endovascular embolization (5) .…”