Arteriovenous malformations of the central nervous system: a review of 53 cases

Analisamos 53 casos de malformações arteriovenosas (MAV) admitidos no Serviço de agosto de 1986 a março de 1998. A distribuição por sexo foi masculino 1,9:1 feminino, com faixa etária média de 32,5±11,5 anos. A apresentação clínica inicial incluiu, em ordem de frequência, hemorragia intracraniana, sinais neurológicos focais, cefaléia, epilepsia, e coma profundo agudo. As MAV supratentoriais tiveram a seguinte distribuição: 10 temporais, 9 parietais, 6 frontais, 3 occipitais, 3 fronto-parietais, 4 corpo caloso/pericalosas, 1 têmporo-occipital, 1 têmporo-parieto-occipital e 6 profundas. As MAV de acordo com a classificação de Spetzler-Martin, distribuiram-se em: grau II 17 casos (32%), grau III 21 casos (39%) e grau IV 10 casos (19%). Em 3 pacientes (5,6%) havia presença concomitante de aneurisma intracraniano. Trinta e sete pacientes foram operados, 12 dos quais, com embolização parcial prévia. Em somente um caso a ressecção cirúrgica foi parcial. Onze pacientes foram somente embolizados, sendo a embolização parcial em 3 casos. Dois pacientes não foram embolizados e nem operados (1 caso devido a pneumonite intersticial por AIDS e outro por problemas administrativos). Três casos foram encaminhados para radiocirurgia. Houve somente um óbito por embolia pulmonar aguda (1,8%). Concluímos que a abordagem multidisciplinar individualizada, envolvendo as especialidades de neurorradiologia intervencionista, neurologia e neurocirurgia, oferece a possiblidade de indicar a terapia mais adequada para cada caso, com bons resultados.Fifty-three patients with arteriovenous malformation (AVM) were studied. The mean age at the time of diagnosis was 32.5±11.5 years (range 3 to 56 years); the sex ratio was male 1.9:1 female. The most commmon clinical presentation was intracranial hemorrhage, followed by focal neurological signs, headache, epilepsy, and acute deep coma. Fourty-three (82%) out of the total number of AVM were supratentorial and had the following distribution: 10 temporal lobe, 9 pariental lobe, 6 frontal lobe, 3 occipital lobe, 3 frontotemporal, 4 corpus callosum/pericalosal, 1 temporo-occipital, 1 temporoparieto-occipital, 6 deep-located (3 thalamic, 3 basal ganglia). Spetzler-Martin grade II was seen in 17 cases (32%), grade III in 21 cases (39%), and grade IV in 10 cases (19%). AVM-associated aneurysms were detected in 3 patients (5.6%). All three cases were middle artery aneurysms ipsilateral to AVM. Twelve (32%) out of 37 operated patients were submitted to embolization prior to surgery. AVM was totally removed in all cases except one. Embolization without posterior surgery was used in 11 patients; in 3 of them, embolization was partial. Two patients were neither embolized nor operated on. Three patients were submitted to radiosurgery because they were poor candidates to embolization and/or surgery. Mortality rate was 1.8%. All patients returned to their normal life function after a period of recovery. Associated or isolated therapies should be individualized to each patient with AVM and is likely to provide results better than the expected outcome without any treatment