Predictors of Cerebral Arteriovenous Malformation Mortality: A Single-center, Five-year Retrospective Study

Authors

  • Patricio Garcia-Espinosa Medical student. Universidad Autónoma de Nuevo León, Mexico
  • Edgar Botello-Hernández Universidad Autónoma de Nuevo León
  • Gabriela Torres-Hernández Universidad Autónoma de Nuevo León
  • Clarissa Guerrero-Cavazos Universidad Autónoma de Nuevo León, Mexico
  • Estefania Villareal-Garza Universidad Autónoma de Nuevo León, Mexico
  • Andrea Flores-Rodriguez Universidad Autónoma de Nuevo León

DOI:

https://doi.org/10.5195/ijms.2021.884

Keywords:

Nervous System Malformation, Arteriovenous Fistula, Cerebral Hemorrhage, Intracranial Hemorrhages, Arteriovenous Malformation

Abstract

Background: Arteriovenous Malformations (AVMs) are abnormalities in intracranial vessels between the arterial and venous systems. This study aimed to identify the predictors of mortality in patients that presented to our hospital with AVMs, ruptured or unruptured, and correlate them to those available in the literature.

Methods: An analytical, observational, retrospective study was performed to review data of patients with cerebral AVMs in the University Hospital “Dr José Eleuterio González” from January 2016 to December 2020. Clinical files were reviewed based on AVMs diagnosis according to the  International Classification of Diseases 10th Revision, ICD-10. Variables were subjected to a univariate analysis and those found significant (p-value < 0.05) were subjected to a logistic regression.

Results: A total of 80 patients were included in our study. Most of the participants were females (56.3%) and three were pregnant. The most common presenting symptom was holocranial headache (34 cases) occurring between the hours of 22:00 to 7:00. The most significant predictors of mortality were a total bleeding volume greater than 9.18 cm3 (p = 0.010), the presence of more than one symptom (p = 0.041), and a history of previous cerebral intraparenchymal hemorrhage (p = 0.014).

Conclusion: Results demonstrated an important association between intracranial bleeding and mortality. Ultimately, more prospective studies are needed to determine predictor factors for mortality in AVMs patients.

Metrics

Metrics Loading ...

References

Ajiboye N, Chalouhi N, Starke RM, Zanaty M, Bell R. Cerebral arteriovenous malformations: evaluation and management. ScientificWorldJournal. 2014 Oct 15;2014:649036-.

Tranvinh E, Heit JJ, Hacein-Bey L, Provenzale J, Wintermark M. Contemporary imaging of cerebral arteriovenous malformations. Am J Roentgenol. 2017 Jun;208(6):1320–30.

Chen C-J, Ding D, Derdeyn CP, Lanzino G, Friedlander RM, Southerland AM, et al. Brain arteriovenous malformations: A review of natural history, pathobiology, and interventions. Neurology. 2020 Nov 17;95(20):917–27.

Komiyama M. Pathogenesis of Brain Arteriovenous Malformations. Neurol Med Chir (Tokyo). 2016 Jun 15;56(6):317–25.

StatPearls Publishing. Arteriovenous Malformation (AVM) Of The Brain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430744/. Last updated Jun 30, 2020; cited Jan 10, 2021.

Di Rocco C, Tamburrini G, Rollo M. Cerebral arteriovenous malformations in children. Acta Neurochir (Wien). 2000 Feb;142(2):145–8.

Hofmeister C, Stapf C, Hartmann A, Sciacca RR, Mansmann U, terBrugge K, et al. Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation. Stroke. 2000 Jun 1;31(6):1307–10.

Abecassis IJ, Xu DS, Batjer HH, Bendok BR. Natural history of brain arteriovenous malformations: a systematic review. Neurosurg Focus. 2014 Sep;37(3):E7.

El-Ghanem M, Kass-Hout T, Kass-Hout O, Alderazi YJ, Amuluru K, Al-Mufti F, et al. Arteriovenous Malformations in the Pediatric Population: Review of the Existing Literature. Interv Neurol. 2016 Sep;5(3–4):218–25.

Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986 Oct;65(4):476–83.

Turjman F, Massoud TF, Viñuela F, Sayre JW, Guglielmi G, Duckwiler G. Aneurysms related to cerebral arteriovenous malformations: superselective angiographic assessment in 58 patients. AJNR Am J Neuroradiol. 1994 Oct;15(9):1601–5.

Mossa-Basha M, Chen J, Gandhi D. Imaging of cerebral arteriovenous malformations and dural arteriovenous fistulas. Neurosurg Clin N Am. 2012 Jan;23(1):27–42.

Friedlander RM. Clinical practice. Arteriovenous malformations of the brain. N Engl J Med. 2007 Jun 28;356(26):2704–12.

Brown RDJ, Flemming KD, Meyer FB, Cloft HJ, Pollock BE, Link ML. Natural history, evaluation, and management of intracranial vascular malformations. Mayo Clin Proc. 2005 Feb 1;80(2):269–81.

Choi JH, Mohr JP. Brain arteriovenous malformations in adults. Lancet Neurol. 2005 May 1;4(5):299–308.

Pollock BE, Flickinger JC. A proposed radiosurgery-based grading system for arteriovenous malformations. J Neurosurg. 2002 Jan;96(1):79–85.

Mohr JP, Parides MK, Stapf C, Moquete E, Moy CS, Overbey JR, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet (London, England). 2014 Feb 15;383(9917):614–21.

Elhammady MS, Heros RC. the ARUBA study: where do we go from here? J Neurosurg. 2017 Feb;126(2):481–5.

Rutledge WC, Ko NU, Lawton MT, Kim H. Hemorrhage rates and risk factors in the natural history course of brain arteriovenous malformations. Transl Stroke Res. 2014 Oct;5(5):538-42.

World Health Organization. Chapter XVII: Congenital malformations, deformations and chromosomal abnormalities. International Statistical Classification of Diseases and Related Health Problems 10th Revision. Avaible from: https://icd.who.int/browse10/2019/en. Last updated 2019; cited Sep 01,2021.

IBM Corp. (2015). IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.

Rodríguez-Parra V, Aburto-Murrieta Y, Zenteno-Castellanos MA. [ Description of clinical and angiographic factors associated with hemorrhage in cerebral arteriovenous malformations treated with embolization]. Arch Neurocien. 2010 Oct;15(4):211–6. Spanish

Rinaldi M, Mezzano E, Berra MS, Parés HR, Olocco RV, Papalini FR. Arteriovenous Malformations - checking and descriptive analysis of 52 AVMs treated for the 2000-2010 period. Surg Neurol Int. 2015 Oct 12;6(Suppl 20):S511-S23.

Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, et al. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017 Jun 22;48(8):e200–24.

Carvalho CS, Resende F, Centeno MJ, Ribeiro I, Moreira J. [ Anesthetic Approach of Pregnant Woman with Cerebral Arteriovenous Malformation and Subarachnoid Hemorrhage during Pregnancy: Case Report]. Brazilian J Anesthesiol. 2013 Mar-Apr;63(2):223-6. Spanish

Goya MM, Plasencia WM, Domingo J, Arencibia A, Barber MA, García-Hernández JA. [Intracranial hemorrhage associated with arteriovenous malformations]. Clin Invest Ginecol Obstet. 2004;31(10):370–5.Spanish

Vega-Basulto SD, Lafontaine-Terry E, Gutiérrez-Muñoz FG, Roura-Carrasco J, Pardo-Camacho G. [Intracranial hemorrhage due to aneurysms and arteriovenous malformations during pregnancy and puerperium. Neurosurgery]. 2008;19(1):25–34. Spanish

Hillman J. Population-based analysis of arteriovenous malformation treatment. J Neurosurg. 2001 Oct;95(4):633–7.

Riordan CP, Orbach DB, Smith ER, Scott RM. Acute fatal hemorrhage from previously undiagnosed cerebral arteriovenous malformations in children: a single-center experience. J Neurosurg Pediatr. 2018 Sep;22(3):244–50.

Sahlein DH, Mora P, Becske T, Huang P, Jafar JJ, Connolly ES, et al. Features predictive of brain arteriovenous malformation hemorrhage: extrapolation to a physiologic model. Stroke. 2014 Jul 12;45(7):1964–70.

Schramm J, Schaller K, Esche J, Boström A. Microsurgery for cerebral arteriovenous malformations: subgroup outcomes in a consecutive series of 288 cases. J Neurosurg. 2017 Apr;126(4):1056–63.

Xie DX, Dedmon MM, O’Connell BP, He LL, Wellons III JC, Rivas A. Surgical management of a hemorrhagic pediatric brainstem cavernous malformation–A case report. Otolaryngol Case Reports. 2017;3:7–9.

Riordan CP, Orbach DB, Smith ER, Scott RM. Acute fatal hemorrhage from previously undiagnosed cerebral arteriovenous malformations in children: a single-center experience. J Neurosurg Pediatr. 2018 Sep;22(3):244–50.

Tascu A, Pascal C, Florea SM, Mircea S. Spontaneous intracranial hemorrhage in children – ruptured lobar arteriovenous malformations: report of two cases. Romanian Neurosurgery. 2015 Mar 15;22(1):85-92.

Pezeshkpour P, Dmytriw AA, Phan K, Shroff MM, Dirks P, Kulkarni A V, et al. Treatment strategies and related outcomes for brain arteriovenous malformations in children: a systematic review and meta-analysis. Am J Roentgenol. 2020 Aug;215(2):472–87.

Richard SA, Shrestha SS, Zhang C, Fu W, Wang T, Cong W, et al. Successful treatment of a child with ruptured arteriovenous malformation using onyx embolization: a case report. Open J Mod Neurosurg. 2017 Oct;7(4):153–63.

Sappenfield EC, Jha RT, Agazzi S, Ros S. Cerebral arteriovenous malformation rupture in pregnancy. BMJ Case Rep. 2019 Jul 23;12(7):e225811.

Nuñez M, Quintana V, Pereira S. [ Cesarean section in a patient with a large cerebral arteriovenous malformation: anesthetic considerations]. Anest Analg Reanim. 2012;25(1):39–42.Spanish.

Published

2021-08-31

How to Cite

Garcia-Espinosa, P., Botello-Hernández, E. ., Torres-Hernández, G. ., Guerrero-Cavazos, C. ., Villareal-Garza, E., & Flores-Rodriguez , A. . (2021). Predictors of Cerebral Arteriovenous Malformation Mortality: A Single-center, Five-year Retrospective Study. International Journal of Medical Students, 9(3), 213–218. https://doi.org/10.5195/ijms.2021.884

Issue

Section

Original Article

Categories

Most read articles by the same author(s)