Abstract
The main aim of the treatment of ruptured cerebral arteriovenous malformations (AVMs) is to prevent rebleeding. We analyzed the rate and the timing of re-hemorrhage of ruptured cerebral AVMs in a consecutive series of patients admitted to our institute. The total number of patients was 127 (79 males, 48 females), admitted in our university hospital from 1979 to 2009. Hemorrhagic and non-hemorrhagic presentation was recorded in 68 and 59 cases, respectively. The AVMs were diagnosed with catheter angiography, magnetic resonance imaging or enhanced computed tomography. Spinal AVM, dural arteriovenous fistula, cavernous malformation and venous angioma were excluded.
The data of patients admitted to our hospital before 2008 were searched retrospectively, whereas data from patients admitted from 2008 and later were subjected to prospective tracing surveys, and the location of nidi, treatment modality, timing of hemorrhage after the onset and neurological outcomes were investigated. We specially focused on the re-hemorrhagic rate in the acute phase and analyzed the data minutely. Re-hemorrhagic risk decreased 400 days after the first hemorrhage and became constant. Re-hemorrhage during the follow-up period seems to be one of the causes of neurological deterioration, but re-hemorrhage in the acute phase did not result in a significant incidence of mortality.
Early re-hemorrhage of cerebral AVMs was not considered as frequent or catastrophic as ruptured aneurysms. Our clinical data support our treatment strategy of avoiding aggressive early treatments for ruptured cerebral AVMs.
