gms | German Medical Science

Objective: To present clinical, angiographical and therapeutical characteristics of patients with sporadic multiple AVMs, treated in our institution.

Method: Patients with cerebral AVMs, treated in our department between 1990 and 2013, were analyzed retrospectively. Basic demographic data, vascular architecture, clinical presentation, treatment strategies and treatment outcome were evaluated.

Results: Six out of 481 patients (1.2 %) with cerebral AVMs harboured 15 multiple and distinct cerebral lesions. In four patients, AVMs were located bilaterally and nidus size was predominantly small, consecutively determining a °I-°III, according to the Spetzler-Martin grading system. In three patients, AVMs shared a proximal feeding artery supply, whereas each AVM displayed ist own venous drainage. Five of six patients (83 %) presented with hemorrhage from rupture of an AVM nidus. Four patients received therapy of the AVMs with complete exclusion in 3/4 patients (75 %) and 8/9 treated AVMs (89 %). All patients with treatment of the AVM showed a good to excellent recovery (n = 4, mRS 1-2).

Conclusions: Multiple cerebral AVMs are complex vascular lesions and multiplicity of hemodynamic variables highly influences treatment strategies and sequences. Thus, treatment principles for multiple and single AVMs remarkably differ and awareness of potential hemodynamic interactions between distinct lesions before and during treatment is of utmost importance. The high number of hemorrhagic events justifies indication to treat these lesions.