Brain arteriovenous malformations: Angioarchitecture and clinical presentation

Abstract

Problem/background : Hemorrhage is the most significant risk in patients with brain arteriovenous malformations (AVMs). Although several factors have been found associated with hemorrhagic events, it is not known with certainty whether specific angioarchitectural aspect predispose patients with brain AVMs to any specific clinical presentation.

Objective : The purpose of this study was to assess demographic, clinical and morphological characteristics of patients with brain arteriovenous malformations and to identify significant factors related to the initial hemorrhagic presentation.

Design : Descriptive study.

Setting : Department of Radiology, Faculty of Medicine, Chulalongkorn University

Material and Methods : Clinical and angiographic data from 104 patients with brain AVMs at King Chulalongkorn Memorial Hospital were retrospectively reviewed. Angiographic architectures such as, size, location, arterial supply and venous drainage pattern were recorded. Univariate and multivariate analyses were conducted in order to test the association between the morphological features and clinical presentation.

Results : From a total of 104 patients, hemorrhage was an initial presentation in 64 cases (61.5%). By univariate analysis, small nidus size (p = 0.0001), single feeding artery (p = 0.0003), single draining vein (p <0.0001) and deep venous drainage (p = 0.002) were associated with hemorrhage. When we used stepwise multiple logistic regression analysis, single feeding artery (OR 6.68, 95%CI 1.39 to 32.08; p = 0.018) and single draining vein (OR 5.24, 95%CI 2.04 to 13.47; p = 0.001) were independently associated with hemorrhage.

Conclusions : Single feeding artery and single draining vein were significant factors associated with initial hemorrhagic presentation. In contrast with many previous reports, AVM size, location, and presence of deep venous drainage were not associated with hemorrhage at presentation in adjusted analyses.