Collaborative management of intracranial arteriovenous malformation

Objectives: To study all the cases of intracranial malformation present to a main artereovenous malformation presented to main neurosurgical center in Saudi Arabia and compare the results with reports from outside the Kingdom , To estimate the hospital-bused prevalence of the disease which may reflec t the frequency in the Saudi Arabia. Methods: A retrospective study was conducted to analyze the cases of intrac ranial arteriovenous malformation admitted to King Faisal Specialist Hospit al and Research Center from 1982 to 1996. Results: A total of 97 patients were eligible far the present study. The ch aracteristic aspects of intracranial arteriovenous malformation matched wel l with reports from other parts of the world. The hospital-based frequency was calculated to be 40 per 100.000 admissions. Most of the patients were m en (2.5 men: 1 woman). The average age at presentation was 29 years. More t han half the patients presented with intracranial hemorrhage (52%): seizure was 2nd in frequency (32%). More than 80% of the arteriovenous malformatio ns were in the supratentorial location, the rest were in the infratentorial location. According to the Spetzler and Martin grading system, 16 patients presented with grade I, 43 with grade II, 28 with grade III, 13 with grade IV, and one patient with grade arteriovenous malformation. Three patients had double arteriovenous malformation. The patients were managed by single or combined procedures, which included surgery (28.9%). endovascular emboli zation and radiosurgery (16.5%). The complications included transient or pe rsistent neurological deficit, status epilepticus. and immediate post-embol ization intracerebral hemorrhage which proved fatal in one case. The differ ent variables were tested for predictability of the risk of bleeding. The r esults were compared with those reported in the literature. Conclusion: Intracranial artereovenous malformation is not uncommon in Saud i Arabia. The patient presentation, arteriovenous malformation classificati on in each grade, and treatment outcome correlated well with other reports in the literature. The best obliteration rate was observed with surgical ex cision of the malformation (75%). No therapeutic modality was without compl ication.