.48 Cases Of Cerebral Arteriovenous Arteriovenous Malformation Clinical Analysis Of The Number Of Draining Veins

Objective: Through the analysis and follow-up with 48 patients,we can explore relations between the number of draining vein and sex,age,initial symptoms,operation methods and Spetzler-Martin grades,further definite the effect of microsurgical resection,endovascular embolization and combined embolization and microsurgery treatment,with respect to the number of AVM′draining vein.Materials and Methods: There are 48 patients with a mean age of 33.5 years ,(23 men and 25 women,range 13-56 years) Intracranial hemorrhages represented initial symptoms in 28 cases,seizures in 8,headaches in 7 ,other symptoms in 5.All patients were diagnosised by DSA ,35 patients were examined by MRI and 27 cases were confirmed by pathologic results.Thirty-two AVMs have one draining vein and 16 AVMs have more draining veins.Patients were divided into microsurgical resection group,endovascular embolization group and combined group by different treatment.In resection group,19 patients underwent total resection with microscopy after diagnosis,on select time.In emergency treatment,clearing hematoma and resecting total AVMs were performed in 5 patients.Two patients get rid of part of skull bone furthermore.In embolization group,all patients were embolized with Onyx18.Fifteen cases apply simple embolization,and 4 patients were drilled for draining hematomas.Combined group have 3 patients with embolization followed by resection.We summarized connection between sex,age,initial symptoms,operation methods,Spetzler-Martin grades,incidence of complication, situation of follow-up visits.and the number of AVM′draining vein.Immediate complications﹙1 week﹚include①death,②hemiparalysis,③hemianopia,④aphasia,⑤infection,⑥cranial nerve dysfunction⑦postoperative hyperperfusion injury.A long-term follow-ups﹙6 months﹚ were assessed according to the Glasgow Outcome Scale﹙GOS﹚.The meanings of well recovery are GOS≧4 grades.we regard incidence of complications and well recovery rate as standard.In the end, all the data have been analysed with X2test of statistics. Results:1 When AVM have only one draining vein,resection group have 8 cases with complications which are closely correlated operation.they are two hemiparalysis,two aphasia,two hemianopias,one infection and one hyperperfusion. Embolization group have 4 cases,which are one hemiparalysis,one aphasia,and one patients have hemiparalysis,aphasia and hemianopia.Combined group have one hemianopias.2 Thirty-two AVMs were visited by telephone,and follow-up rate is 67%.Well recovery rate in resection group,embolization group and combined group is 88%,92% and 100% respectively.All patients have no rebleeding.Resection group have two death and one patient has permanent disability in embolization group3 After statistical analysis,we discover the incidence of complications was striking difference (P=0.03﹤0.05) between draining vein﹦1 group and﹥1 group which were divided according to the number of AVM′draining vein.Microsurgery have more complications,when malformation nest with only one draining vein.Other group have no statistical meanings.Conclusions: The number of AVM′draining vein is an important index in order to study the AVM which belong to congenital disorders.Through reviewing and analyzing clinical materials,we can find that there is no striking relations between the number of draining vein and sex,age,initial symptoms,operation methods,Spetzler-Martin grades,well recovery rate,complications of embolization or of combined treatment.It is most important to show that microsurgery have more complications,when malformation nest with only one draining vein.In the light of statistical results of draining vein,we can have a better understanding of AVM. The number of AVM′draining vein should be regarded as one of the best index in comprehending AVM.It should be judicious to select microsurgery,when discovering malformation nest with only one draining vein,especially.In short,for treating AVM, we should link initial symptoms ,age,sex,furthermore,take the number of AVM′draining vein as one of the best index.All patients should be given positively examination with DSA and MRI,and assessing the size,location,feeding artery,draining vein,Spetzler-Martin grades of AVM. At last all patients should be dealed with specific treatment,so that we can achieve expectant outcome.