Clinical features and management of brain arteriovenous malformations in elderly patients.

Abstract:

BACKGROUND:Brain arteriovenous malformations (AVMs) of the elderly have not received sufficient attention, given the increase in age of individuals in recent years. We therefore designed a retrospective study to clarify features of brain AVMs in this age group in comparison with their counterparts in the general population. METHODS:A retrospective study was performed, based on data for AVMs treated in Nara Medical University Hospital and affiliated hospitals over the past 13 years. The series included all cases of brain AVMs, except for pure dural AVMs, diagnosed from June 1989 to June 2003. A total of 175 patients were diagnosed as having an AVM during this period, including 32 patients more than 60 years old. Clinical features and effective treatment of brain AVMs in those over and under 60 were explored and outcome at 3 to 6 months after surgery was evaluated according to a modified neurological scale. FINDINGS:The most common mode of presentation was intracranial hemorrhage in both groups, and this was remarkable in the elderly. Epilepsy at presentation was less frequent in the elderly (P< 0.05). In the elderly group infratentorial lesions were encountered more frequently (P< 0.05). Good or excellent outcomes of surgery were accomplished in 82.6% of the non-elderly group, and in 69.6% of the elderly group. When restricted to the grades I or II of Spetzler and Martin (S & M) grading, postoperative neurological scores of both groups were significantly better than preoperative values (P < 0.01). In the grade III cases, the non-elderly demonstrated significant improvement after surgery (P <0.01), but the elderly did not. INTERPRETATION:Elderly patients with a brain AVM had clinical features of less frequent epileptic presentation and more frequent infratentorial lesions. It was suggested that surgery was acceptable in elderly patients with pallial AVMs of grade I and II. Surgery for grade III AVMs of the elderly remains to be clarified.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Hashimoto H,Iida J,Kawaguchi S,Sakaki T

doi

10.1007/s00701-004-0346-9

subject

Has Abstract

pub_date

2004-10-01 00:00:00

pages

1091-8; discussion 1098

issue

10

eissn

0001-6268

issn

0942-0940

journal_volume

146

pub_type

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