Angioarchitectural characteristics associated with initial hemorrhagic presentation in supratentorial brain arteriovenous malformations.

OBJECTIVE

The difference in arterial supply, venous drainage, functional localization in supratentorial and infratentorial compartments may contribute to the conflicting results about risk factors for hemorrhage in published case series of brain arteriovenous malformation (bAVM). Further investigation focused on an individual brain compartment is thus necessary. This retrospective study aims to identify angioarchitectural characteristics associated with the initial hemorrhagic event of supratentorial bAVMs.

MATERIALS AND

METHODS

The clinical and angiographic features of 152 consecutive patients with supratentorial bAVMs who presented to our hospital from 2005 to 2008 were retrospectively reviewed. All these patients had new diagnosis of bAVM. Univariate (χ(2) test) and multivariate analyses were conducted to assess the angiographic features in patients with and without initial hemorrhagic presentations. A probability value of less than 0.05 was considered statistically significant in each analysis.

RESULTS

In 152 patients with supratentorial AVMs, 70.6% of deep and 52.5% of superficial sbAVMs presented with hemorrhage. The deep location was correlated with initial hemorrhagic presentation in univariate analysis (χ(2)=3.499, p=0.046) but not in the multivariate model (p=0.144). There were 44 sbAVMs with perforating feeders, 39 (88.6%) of which bled at a significantly higher rate than those with terminal feeders (χ(2)=25.904, p=0.000). 87.5% (21/24) of exclusive deep venous drainage presented with hemorrhage, a significantly higher rate than those of the other type of venous drainage (χ(2)=11.099, p=0.004). All 10 patients with both perforating feeders and exclusive deep draining vein presented with initial hemorrhage. Hemorrhagic presentation was correlated with perforating feeders (p=0.000) and exclusive deep draining vein (p=0.007) in multivariate analysis as well.

CONCLUSIONS

Supratentorial bAVMs with perforating feeders and deep venous drainage have a higher risk of hemorrhage. In contrast with many previous reports, AVM location was not associated with hemorrhagic presentation in adjusted analyses. The correlation between deep location and initial hemorrhage in univariate analysis might be caused by the involved perforating feeders and deep draining vein in the deep located AVMs.