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Journal of Korean Neurosurgical Society 1995;24(10): 1147-1158.
Clinical Study on intracranial Arteriovenous Malformations: Clinical Analysis of 187 Cases.
Ji Young Lee, Sang Hyung Lee, Chang Wan Oh, Dae Hee Han
Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Korea.
In an effort to understand the clinical symptomatology of intracranial arteriovenous malformations(AVMs), to determine their best management policy, and to accumulate our clinical data, a retrospective clinical analysis of 187 patients with intracranial AVMs which were diagnosed by neuroradiological studies or histopathologically was performed during the period from January 1983 to May 1994. Among the 187 patients of whom for patients with dural type AVM and eight referral patients were excluded, 120 patients were treated surgically and the other 55 patients, managed conservatively. The outcome of all patients were analysed and their post-ictal status was followed for an average of 31.7 months. The results were as follows. 1) The peak incidence of intracranial AVMs was in the third decade(mean age 28.9 years) followed by the second decade and the fourth decade. The male to female ration was 1.9:1. 2) The presenting symptoms were mainly intracranial hemorrhage(50.3%), seizure(33.2%) and headache(9.6%). Among the types of intracranial hemorrhage, intracerebral hematoma was the most frequent, and of the seizure type, generalized seizure was seen most frequently. 3) The locations of intracranial AVMs were hemispheric(78%), deep seated(14%), posterior fossa(6%), and dural(2%). 4) The presenting symptoms of intracraial hemorrhage and seizure depended significantly on the size of the AVM;71% of small AVMs(<3cm) presented with hemorrhage, while 53% of large ones(>6cm) presented with seizure. 5) The rate of rebleeding was 21%(20 of 94) and the associated mortality rate was 5%( of 20). 6) Concomitant aneurysms were found in 14 cases(7.5%). 7) In surgically treated cases, the mortality rate was 2.5% and its morbidity rate, 26.7%. In conservatively treated cases, the mortality rate was 3.6% and its morbidity rate, 27.3%. 8) The clinical outcome of children was similar to that of adults. 9) Patients with seizures showed a better outcome than those with hemorrhages and the clinical outcome did not depend on the methods of treatments in either patients with hemorrhages or those with seizures. 10) With respect to the Spetzler-Martin grade, the surgical outcome improved ssignificantly as the grade became lower. 11) There was a marked tendency for postoperative neurological deficits to improve with time during the mean follow-up period(31.7 months). As such, early morbidity rate was 50% and late morbidity rate decreased to 26.7%. 12) Preoperative embolization was effective for a safe surgical removal of the AVMs with a poor grade. 13) Of the patients who did not have seizure before surgery, 7.9%(6/76) had late seizures in whom all were not well controlled with medication. Of the patients who had seizures before surgery, 82.9%(29/35) were either cured or controlled with medication.
Key Words: Cerebral arteriovenous malformations; Intracranial hemorrhag; Seizures; Embolization; Treatment; Outcome
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