Analysis Of Risk Factors In Predicting Hemorrhage And Strategy For The Treatment Of Cerebral Arteriovenous Malformations

Objective:To determine whether there are any specific clinical and radiographic characteristics to predict the risk of bleeding in cerebral arteriovenous malformation(AVM )patients and we could describe AVMs precisely and help estimate AVMs and guide management in clinical decision making.Methods: 1. We collected and analysised 258 cases of AVMs simply. 2. In the second part we analysised the clinical and angiographic indices to identify the main factors that were associated with epilepsy in cerebral arteriovenous malformation patients. Then to creat an equation that can predict the probability of elepsy to help estimate and cure cerebral arteriovenous malformations, cerebral arteriovenous malformations. 80 cases with presentation of hemorrhage and 80 non-hemarrhagic cases were reviewed and 25 indices and 36 levels were evaluated, and multivariate analysis were performed with the Logistic model. When P=0.01, age, the longest diameter of AVMs, volume of AVMs, number of feeding arteries, Vmfv/Vmna (the ratio of the meanblood velocity in the direct or indirect feeding artery (Vmfv) for the area containing AVM to the mean blood velocity in the neighboring feeding artery(Vmna)), diameter of the main feeding artery, classification in our nation and history were negatively correlated with hemorrhage while direction of drainaging veins were positively correlated with hemorrhage;When P=0.05, A/V time, the mean artery pressure were negatively correlated with hemorrhage while location, Vmfv/Vmna, number of main drainaging veins and diameter of the main drainging vein were positively correlated with hemorrhage. The longest diameter of AVMs, direction of drainaging veins and Vmfv/Vmna wereintroducted in the equation eventually. The sensitivity and specificity were both 80%. The longest diameter of AVM, direction of main drainaging veins and history was the most important indices in predicting hemorrhage. 3. The fourth part emphasized to classify clinical, especially angioarchitecttual indices of cerebral arteriovenous mal format ions(AVMs) and find out their represens means of cllecting informations of 80 cases to describe AVMs precisely and help estimate AVMs and guide management in clinical decision making.Results: 71.2% of all patients occurred hemorrhage as their first symptom. 10-19 ages are the fastigium of hemorrhage. Small avms are more occur hemorrhage than large avms;reversely, large avms are more occur seizure. Avms located in frontal> temporal and pariental lobes are more occur seizure than located in other areas. Deep avms are more occur hemorrhage. The dangerous factors of hemorrhage are Avms'location and hemorrhage history. The rate of rebleeding was 12.2% in the first year after diagnosis, and 17. 1% in three years after diagnosis. Five-year mortality rate after diagnosis is 7.6%.Conchsion:The hemorrhage of AVM is significantly concerned with many factors, such as the sizes, Vmfv/Vmna , the locations and the characters of supplying artery and drainning vein. In a word , If we find the AVM with the risk factors of bleeding, we should take active measure to avoid bleeding and analysed to crest a more precise equation. It also offered a way that a more precise equation can be created by means of collecting and studing more cases to improve the estimation of the risks, help guide management in clinical decision making and improve the estimation of prognostication. This helps avoid losses for lacking of experience. AVMs can be described and estimated by the six lines that is size, location, feeding system, shunting system, drainage system and morphological changes of vessels of AVMs. Early-period, staged and comprehensivetreatments are to be adoptable.