Clinical Analysis Of 91 Cases Of Cerebral Arteriovenous Malformation

Objective: Studied the effect of several therapy methods and found the therapy principle of cerebral arteriovenous malformation out though the analysis and following-up of 91 cases.Data and Methods: There are 91 cases in this study, include male 55 and female 36. The age of all patients ranges from 9 to 72, and the average is 29.4y. 54 patients are between 10y and 29y. 72 patients presented with cerebral hematoma as initial symptoms, while 14 presented with ischemic include headache and neurological deficits, another 5 presented epilepsy. 85 were diagnosised by DSA or MRA, 8 by pathologic results. The patients were divided into surgery group; embolism group; conservative treatment group and multiple treatment group. In surgery group, 15 AVMs were resected after had been diagnosised by DSA, 6 cases operated emergency surgery because of the cerebral hematoma. In embolism group, 26 AVMs were embolized after had been diagnosised by DSA, and 1 of them was embolized with coil, 19 with NBCA, 4 with ONYX and 2 of them were failed because the severe vasospasm. 41 cases receive conservative treatment after had been diagnosised by DSA or MRI. 3 patients received multiple treatment, 2 received embolism first then surgery, the other one was operated a surgery first then receiveγ-ray treatment. We summarized the complication after therapy and the rebleeding rate. Evaluated the patients with GOS scale 3 days after therapy (surgerygroup and embolism group were 3 days after operation; conservative treatment group was 3 days after DSA), and calculate the well (5 scores) rate. 81 cases were followed-up, the follow-up rate was 89%. The follow-up time ranged from 8 months to 4 years, the average was 27.9 months. We also evaluated the patients with GOS scale and calculate the well rate. All the data were checked by chi square test.Results: 1,In surgery group, 8 cases had complications which associated with surgery. 2 of them were grade II, 5 were grade III and 1 was grade IV (the patients were divided into 5 groups though Spetzler-Martin grading). In embolism group, 9 cases had complications which associated with operation. 3 of them were grade II, 4 were grade III and 2 were grade IV. Despite of the vasospasm, 2 were grade II, 2 were grade III, 1 was grade IV. In conservative treatment group, 5 cases had complications which associated with AVM. 1 of them were grade II, 2 were grade III and 2 were grade IV. The 2 dead patients were grad II and grade IV respective. There were no complications in multiple treatment group. 2,Evaluated all patients with GOS scale 3 days after the operation, the well rate of surgery group was 67%, while embolism group 85%, conservative treatment group 93%, multiple treatment group 100%. All the data were checked by chi square test, and no significant difference. 3,Evaluated 81 followed-up patients with GOS scale, the well rate of surgery group was 90%, while embolism group 91%, conservative treatment group 91%, multiple treatment group 100%. All data were checked by chisquare test, and no significant difference. 4,In surgery group, 8 cases had complications which associated with surgery. 6 of them were more than grade III, and the rate was 54%. In embolism group, 9 cases had complications which associated with surgery. 6 of them were more than grade III, and the rate was 38%. In conservative treatment group, 9 cases had complications which associated with AVM, include 2 rebleeding cases. 4 of them were more than grade III, and the rate was 17%. There was no complication in multiple treatment group. All data were checked by chi square test, and the rate between surgery group and conservative treatment group had significant difference (P>0.5).Conclusion: Both surgery and embolism could achieve perfect effect to those cases that were grade I and grade II. Surgery group has higher cure rate, embolism has less complications, and conservative treatment group has higher risk of rebleeding. So surgery and embolism should be performed to grade I and grade II patient positive. We can choose surgery or embolism or surgery+embolism to treat grade III patient. The patient who is older than 70, or has problem to treat, or has taboo of operation, could be considered of conservative treatment. To most of grade IV and grade V patient, conservative treatment would get better outcome, especially the one which has not bleed. To some AVM which complicated with aneurysm, had bad vein drainage, or involved ventricle, should be given conservative treatment after those high risk factors of bleeding had been solved. Ifthe AVM must be solved, to achieve a better outcome, multiple treatment should be given. Finally we should draw specific therapy plan though the patient's situation.