Cerebral arteriovenous malformations. Comparative results of surgical vs conservative treatment in 112 cases.

A group of 112 patients affected by cerebral arteriovenous malformations is reviewed. Sixty-six per cent of the cases presented with subarachnoid hemorrhage. Epilepsy was the main clinical feature in 20% of the cases. In 45 cases an intracerebral or intraventricular hematoma was diagnosed by CT-scan, angiography or was found during surgery. Seventy cases (62.5%) were operated upon and 42 cases were treated conservatively. In 57 operated cases, total excision of the AVM was confirmed by postoperative angiography. In this group there was no rebleeding during the follow-up period. Other 13 cases were submitted to partial excision of the AVM or clipping of the feeding vessels. In this latter group, 2 patients had later subarachnoidal rebleeding. Operative mortality was 11% in this series. Mortality caused by the AVM in the non-operated group was 20%. Comparing the morbidity in both groups, the operated group had a much better clinical evolution than the non-operated one. Regarding the final clinically results, an abnormal state of consciousness before surgery, a large size of the AVM and the presence of intracerebral hematoma appear to have a bad prognosis significance.