Brain arteriovenous malformations: cohort study of 302 patients

Introduction: There is a remarkable controvery regarding the appropriate management of brain arteriovenous malformations (AVMs) during the last decade. There are a few studies about brain AVMs in Latin-America. The aim of the current study is to deter-mine the clinical features, management, and outcome of AVMs in Mexico. Patients and methods: Prospective observational study of 302 patients with diagnosis of brain AVM by neuroimaging, carried out in two reference centers in Mexico (Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez and Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran). In each patient the following data were obtained: demographics, clinical presentation, location and morphology of the AVMs, management, and long-term clinical outcome. Results: Brain ACMs were more common in men (57%) than women (43%) and involved mainly young people (65% had less than 35 years-old). Type III of Spetzler-Martin was the most common. Intracranial hemorrhage was the most frequent clinical presentation (41%) parenchyma located, followed by epilepsy and progressive neurological deficit. An invasive treatment was applied in 55% of cases (endovascular therapy or surgery). Long-term clinical outcome showed that 248 patients (82%) had good prognosis (Rankin 0-2), whereas 37 (12%) had severe disability, and death occurred in 17 patients (6%). Conclusions: This series of Mexicans patients with brain AVM showed a male predominance of young people, which often have long-term good clinical outcome. Case fatality rate was low ( 6%) and similar to other international series.