title: The Diagnosis and Management of Brain Arteriovenous Malformations in a Single Regional Center.
abstract: BACKGROUND
  Cerebral arteriovenous malformations are vascular abnormalities in which arteriovenous shunting occurs through an abnormal vascular network (nidus) in the parenchyma. These lesions typically present by the third decade of life with cerebral bleeding, seizures, headache, or neurologic deficits; however, they are sometimes found incidentally.
  
  
  METHODS
  A retrospective analysis of intracranial AVMs referred to a single regional center, over a 7-year period, was performed to review the clinical presentation, pathologic features and management outcomes from January 2005 to December 2012.
  
  
  RESULTS
  We identified 142 patients (56% female, age range 4-69 years). Emergency referrals accounted for 87% of the cohort with the most frequent presentation being headache and/or hemorrhage. More than half (52%) of the cases were observed to have a neurologic deficit on examination. The modal Spetzler-Martin Grade was 3 with 76% of lesions located in areas of eloquent brain and 57% of cases in the dominant hemisphere. Half of the cases had multiple feeder vessels, and 29% were associated with aneurysms. The nidus was obliterated in 91% of cases actively managed. Two thirds of patients were successfully treated with a single modality, the most common being embolization. Only 8% of cases were managed conservatively. Additionally, 93% of aneurysms identified were treated successfully. The complication rate was 7% with 2% of reported infection.
  
  
  CONCLUSIONS
  The burden of AVM management is significantly enhanced by the number of emergency referrals. Interestingly, complication rates are higher in the unruptured cohort. Surgical management is the most effective modality, but it carries the highest complication rate. This accompanied by the challenges of AVM anatomy and associated pathology argue for expert service provision in a single center.
authors.affiliation: Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK. Electronic address: ay276@cam.ac.uk.
authors.forename: Adam M H
authors.initials: AM
authors.lastname: Young
authors.affiliation: Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
authors.forename: Mario
authors.initials: M
authors.lastname: Teo
authors.affiliation: Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Martin
authors.affiliation: Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
authors.forename: Isaac
authors.initials: I
authors.lastname: Phang
authors.affiliation: Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
authors.forename: Jo J
authors.initials: JJ
authors.lastname: Bhattacharya
authors.affiliation: Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
authors.forename: E Jerome
authors.initials: EJ
authors.lastname: St George
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D004630:Emergencies; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012017:Referral and Consultation; D012189:Retrospective Studies; D012606:Scotland; D012720:Severity of Illness Index; D014656:Vascular Surgical Procedures / Q000009:adverse effects
keywords: Arteriovenous malformation; Brain; Embolization; Hemorrhage; Nidus; Radiosurgery