title: Management of arteriovenous malformations in the elderly: a single-center case series and analysis of outcomes.
abstract: OBJECT Treatment of brain arteriovenous malformations (bAVMs) in the elderly remains a challenge for cerebrovascular surgeons. In this study the authors reviewed the patient characteristics, treatments, angiographic results, and clinical outcomes in 28 patients over 65 years of age who were treated at Henry Ford Hospital between 1990 and 2014. METHODS The bAVM database at the authors' institution was queried for records of elderly patients with bAVMs, and data regarding patient demographics, presenting symptoms, bAVM angioarchitecture, treatment modalities, angiographic results, clinical outcomes, and treatment complications were tabulated and analyzed. RESULTS There were 9 male (32%) and 19 female (68%) patients, with an average age ( ± SD) of 73.0 ± 6.95 years. The most common symptoms on presentation were hemorrhage (36%) and headaches (18%). The bAVMs were equally distributed between the supra- and infratentorial compartments. The most common Spetzler-Martin grade was II, observed in 57% of the patients. Eleven patients (39.3%) underwent resection, 4 patients (14.3%) received standalone radiation therapy, and 13 patients (46%) did not receive treatment or were managed expectantly. Four patients (14.3%) were lost to follow-up. Complete bAVM obliteration was achieved in 87% of the treated patients. None of the patients who received any form of treatment died; the overall mortality rate was 3.6%. CONCLUSIONS Surgical management of bAVMs in the elderly can result in complete obliteration and acceptable clinical outcomes.
authors.affiliation: Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Aqueel H
authors.initials: AH
authors.lastname: Pabaney
authors.affiliation: Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Reinard
authors.affiliation: Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Max K
authors.initials: MK
authors.lastname: Kole
authors.affiliation: Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Seyfried
authors.affiliation: Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Ghaus M
authors.initials: GM
authors.lastname: Malik
mesh_terms: D000367:Age Factors; D000368:Aged; D002533:Cerebral Angiography; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016634:Radiosurgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: ARUBA = A Randomized trial of Unruptured Brain AVMs; AVM = arteriovenous malformation; ICH = intracerebral hemorrhage; SCA = superior cerebellar artery; SM = Spetzler-Martin; SRS = stereotactic radiosurgery; arteriovenous malformation; bAVM = brain AVM; elderly; mRS = modified Rankin Scale; microsurgery; stereotactic radiosurgery; vascular disorders