Baseline Survey Of Brain Arteriovenous Malformations And Risk Factors Analyses Of Bleeding

Background:Brain arteriovenous malformations(BAVM)is an abnormal communication.lack of capillary beds,between arteries and vins of brain. Vascular malformation group consists of feeding arteries, the lesion and draining veins. The incidence rate is about1.11-1.4/1.000.000, and annual bleeding rate is about2%to4%.DSA is the "gold standard" to present feeding arteries, lesions and draining veins of BAVM. The biggest risk to BAVM patients is the stoke caused by ruptured hemorrhagic vascular malformation group.BAVM is one of the important causes of non-traumatic intracranial hemorrhage of adolescents, Currently there is no baseline information of BAVM comes from multicenter in domestic, and risk factors of BAVM bleeding still to be further defined.Objective:Getting a simple understanding about Baseline data of BAVM patients in the First Affiliated Hospital, Zhejiang University, to acquire the risk factors of bleeding.Understanding the First Affiliated Hospital, Zhejiang University BAVM from Extract BAVM bleeding; as part of the national brain arteriovenous malformations multicenter study, this study also establish cerebral arteriovenous malformation database, while making a contribute to draft a relatively complete, being corresponding to the evidence-based medicine and national conditions, treatment strategies and Guideline of BAVM.Methods:Collect the baseline data of112patients newly diagnosed BAVM during the March--2007and April-2012, First Affiliated Hospital of Zhejiang University School of Medicine, including gender, age, the first symptom, Spetzler-Martin grading, lesion sizes, the number of feeding arteries, draining veins, with or without combination with other intracranial vascular abnormalities, treatment strategies, complications, length of stay, to conduct a survey of overall distribution.Based on the results of CT imaging, the patients were divided into hemorrhage group (73cases) and non-bleeding group (39cases).According to the collected baseline data,analyzing single factors that may cause BAVM bleeding, such as:gender, age, lesion sites, the number of feeding arteries, draining veins, with or without combination with other intracranial vascular abnormalities, analyzing the multivariate Logistic regression with meaningful results, and drawing conclusions from them.Results:Baseline data:There were totally112patients newly diagnosed brain arteriovenous malformations in Our hospital from March2007to April2012, including73males and39females, the ratio is1.87:1; the youngest patient was7years old, and the maximum63, the average age was32.20±14.00years old, the20-39-year-old was the peak, occupying50%of the total number; first symptom of hemorrhagic symptoms (headache, limb weakness, disturbance of consciousness, etc.), accounting for65.18%, followed by ischemic symptoms (16.96%) and epilepsy (11.61%); more than90%BAVM located supratentorially, the temporal lobe occupying the largest proportion, intraventricular BAVM can rarely be seen,subtentorial BAVM is less than the10%of total number,mainly located in the cerebellum, rarely on the brainstem.The76.80%of BAVM located at the superficial brain,23.20%in deep.AVM generally meanly located on each side of the hemisphere, seldomly went across the midline; I～IV level of Spetzler-Martin grade roughly occupy the same proportion, V level BAVM was relatively rare, there was no class VI;25.89%of the patients accompanied by other intracranial vascular abnormalities, in which aneurysms were more common; approximately half of the BAVM has only one feeding artery,3feeding arteries and above are relatively rare;59.82%BAVM are drained by the superficial veins,31.25%the deep, and less than10%of patients exist two-directions venous drainage; the the proportions of patients gotten conservative treatment and surgery were both25.89%. the proportion of patients gotten GSK treatment was12.50%, and14.29%of the patients were just embolized, and the another21.43%were gotten the comprehensive treatments, the overall complications (including blood loss, postoperative bleeding, intracranial infection, nerve dysfunction) rate was10.71%, the mortality rate was4.46%; patients with an average length of stay was22.05±19.06days. Risk factors of bleeding:Make Single-factor analyses of gender, age, with or without other intracranial vascular abnormalities, the maximum diameter of BAVM lesions, the number of feeding arteries, draining veins, the positions of BAVM,we can get the result that:younger than40years old, BAVM maximum diameter<=3cm, feeding arteries<=2, BAVM locate in deep brain tissues are risk factors of bleeding.multivariate logistic analysis shows "younger than40years" and "maximum diameter of<=3cm" are the two risk factors.Conclusions:BAVM is common in young people, the incidence of men is approximately1time higher than women; the hemorrhagic symptoms、ischemic symptoms, epilepsy are the three most common performances of BAVM; the BAVM is commonly can be seen on one side of the superficial hemisphere above tentorial. There are commonly1to2feeding arteries. the draining veins are often superficial. about1/4of the patients are accompanied with other intracranial vascular abnormalities; only a few patients are class V of S-M classification; Current treatments are conservative therapy,surgery, embolization, Gamma Knife and combination therapy, the overall complication rate was10.71%, and the mortality rate was4.46%; younger than40years old, BAVM maximum diameter of<=3cm, are two risk factors need to be watch out for.