caa a22 4500 60621528X CHVBK 20210128101058.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00701-015-2521-6 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2521-6 Brain arteriovenous malformations in elderly patients: clinical features and treatment outcome [Elektronische Daten] [Xianzeng Tong, Jun Wu, Fuxin Lin, Yong Cao, Yuanli Zhao, Bo Ning, Bing Zhao, Lijun Wang, Shuo Zhang, Shuo Wang, Jizong Zhao] Background: In this aging society, attention has not been fully given to brain arteriovenous malformations (AVMs) in elderly patients. This study sought to describe a single institution's experience treating arteriovenous malformations (AVMs) in elderly patients. Methods: We conducted a retrospective review of brain AVMs in elderly patients treated at our institution between 1990 and 2012 with a focus on the clinical features, risk of hemorrhage and treatment outcomes. Results: Of the 2790 patients in our AVM database, 98 patients were over the age of 60 at presentation. Forty-eight percent presented with hemorrhage. Risks of initial hemorrhage were history of hypertension, smaller AVM size (<3cm) and exclusively deep venous drainage. Treatment modalities were microsurgical resection in 65%, embolization alone in 10%, stereotactic radiosurgery (SRS) in 11% and observation in 14%. Preoperative embolization was performed in 32% in the surgical group. Complete obliteration was achieved in 95% by microsurgery, 30% by embolization alone and 45% by SRS. Good functional outcome (modified Rankin Scale, mRS <2) was achieved in 69% after a median follow-up of 5.8years. Multivariate logistic analysis revealed that a pretreatment mRS score ≥2, eloquent location and higher S-M grade (IV or V) were associated with worsening functional status, whereas surgical resection was a negative factor. Posttreatment hemorrhage occurred in 8%. AVM-related death occurred in three patients (2 by surgery and 1 by observation). Conclusions: Brain AVMs in elderly patients still pose a high risk of hemorrhage. Initial hemorrhage may be associated with a history of hypertension, AVM size and exclusively deep venous drainage. Initial mRS score ≥2, eloquent location and higher S-M grade may be associated with worsening functional status. Microsurgical resection can be safe and effective for selected patients. Preoperative embolization is helpful in patients with S-M grade IV-V AVMs. For those with surgical contraindications, SRS and observation are treatment alternatives. Springer-Verlag Wien, 2015 Arteriovenous malformations (AVMs) nationallicence Patients over 60 nationallicence Clinical features nationallicence Management nationallicence Tong Xianzeng Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Wu Jun Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Lin Fuxin Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Cao Yong Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Zhao Yuanli Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Ning Bo Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Zhao Bing Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Wang Lijun Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Zhang Shuo Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Wang Shuo Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Zhao Jizong Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1645-1654 0001-6268 157:10<1645 2015 157 701 https://doi.org/10.1007/s00701-015-2521-6 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2521-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tong Xianzeng Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Wu Jun Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Lin Fuxin Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Cao Yong Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Zhao Yuanli Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Ning Bo Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Zhao Bing Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Wang Lijun Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Zhang Shuo Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Wang Shuo Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 700 1- Zhao Jizong Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050, Beijing, People's Republic of China aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1645-1654 0001-6268 157:10<1645 2015 157 701