[Arteriovenous malformations of the central nervous system. Analysis of 53 cases].

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 common 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.