Brain arteriovenous malformations in elderly patients: clinical features and treatment outcome.
BACKGROUND
In this aging society, attention has not been fully given to brain arteriovenous malformations (AVMs) in elderly patients. This study sought to describe a single institution's experience treating arteriovenous malformations (AVMs) in elderly patients.


METHODS
We conducted a retrospective review of brain AVMs in elderly patients treated at our institution between 1990 and 2012 with a focus on the clinical features, risk of hemorrhage and treatment outcomes.


RESULTS
Of the 2790 patients in our AVM database, 98 patients were over the age of 60 at presentation. Forty-eight percent presented with hemorrhage. Risks of initial hemorrhage were history of hypertension, smaller AVM size (<3 cm) and exclusively deep venous drainage. Treatment modalities were microsurgical resection in 65 %, embolization alone in 10 %, stereotactic radiosurgery (SRS) in 11 % and observation in 14 %. Preoperative embolization was performed in 32 % in the surgical group. Complete obliteration was achieved in 95 % by microsurgery, 30 % by embolization alone and 45 % by SRS. Good functional outcome (modified Rankin Scale, mRS <2) was achieved in 69 % after a median follow-up of 5.8 years. Multivariate logistic analysis revealed that a pretreatment mRS score ≥2, eloquent location and higher S-M grade (IV or V) were associated with worsening functional status, whereas surgical resection was a negative factor. Posttreatment hemorrhage occurred in 8 %. AVM-related death occurred in three patients (2 by surgery and 1 by observation).


CONCLUSIONS
Brain AVMs in elderly patients still pose a high risk of hemorrhage. Initial hemorrhage may be associated with a history of hypertension, AVM size and exclusively deep venous drainage. Initial mRS score ≥2, eloquent location and higher S-M grade may be associated with worsening functional status. Microsurgical resection can be safe and effective for selected patients. Preoperative embolization is helpful in patients with S-M grade IV-V AVMs. For those with surgical contraindications, SRS and observation are treatment alternatives.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Xianzeng
X
Tong
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Jun
J
Wu
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Fuxin
F
Lin
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Yong
Y
Cao
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Yuanli
Y
Zhao
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Bo
B
Ning
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Bing
B
Zhao
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Lijun
L
Wang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Shuo
S
Zhang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China. captain9858@vip.sina.com.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China. captain9858@vip.sina.com.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China. captain9858@vip.sina.com.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China. captain9858@vip.sina.com.
Shuo
S
Wang
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.|China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.
Jizong
J
Zhao
D000368:Aged; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000209:etiology*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects*
Arteriovenous malformations (AVMs); Clinical features; Management; Patients over 60