gms | German Medical Science

Objective: In ruptured arteriovenous malformations (rAVM) with associated intracerebral hemorrhage (ICH) the question remains if rather the ICH score or AVM grading scores should be used to predict patient outcome.

Method: Single center analysis from 01/2006 to 12/2013 of patient data with newly diagnosed ICH due to rAVM with a modified Rankin Scale (mRS) >2 before ICH. Patients were grouped in acceptable (mRS 0-3) and worse (mRS 4-6) outcome at LFU (mean 32 months) to compare the following parameters using Fisher's exact test: ICH score (age, GCS, hemorrhage volume, localization), Spetzler-Martin grade (AVM size, eloquency, venous drainage), the supplementary Lawton grading scale (age, ruptured AVM, nidus structure) as well as further radiographic data (Spot sign, associated aneurysms, intraventricular hemorrhage), pre-/postruptured treatment modalities (embolization, radiotherapy, surgery, none) and outcome (mRS, GOS).

Results: A total of 67 patients (mean age 41years, 66% male) were analyzed including 39 patients with acceptable and 28 with worse outcome. Two patients from the worse outcome group died and 2 patients had a mRS of 5 at LFU. Intraventricular hemorrhage (p=0.048), ICH score (p=0.003), AVM size (p<0.0001), Spetzler-Martin grade (p<0.0001), Nidus structure (p=0.005), Lawton grading scale (p=0.015), Combined Spetzler-Martin-Lawton score (p<0.0001) were significant predictors for good outcome in ICH associated rAVMs. Pre-ICH embolization was higher in the worse outcome group compared to the acceptable outcome group (29 vs 10%). Patients from the acceptable outcome group were more likely treated surgically (ICH + AVM resection) than worse outcome patients (54 vs 32%). None of the patients showed an ICH related spot sign and both groups showed comparable AVM associated aneurysms.

Conclusions:

0.

Besides the ICH score, the supplemented Spetzler-Martin-Lawton grading system was useful to predict outcome after rAVM with associated ICH.

1.

Since there is no AVM associated ICH grading score available in the literature, we currently validate a novel grading score.

2.

There were no spot sign patients in this cohort, which might explain the lower pressure character of the AVM associated ICHs and a more acceptable patient outcome than expected.