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  • Management of Intracranial AVMs in the Elderly.

    Final Number:

    Aqueel Pabaney MD; Kevin Reinard MD; Ghaus M. Malik MD

    Study Design:

    Subject Category:
    Vascular Malformations

    Meeting: AANS/CNS Cerebrovascular Section 2015 Annual Meeting

    Introduction: No reports or guidelines exist regarding management of AVMs in elderly population. We set out to seek the safety and effectiveness of management of intracranial AVMs in patients aged > 65 years.

    Methods: Henry Ford AVM Database was queried for patients presenting with ruptured or unruptured intracranial AVMs at age 65 years or above. Data regarding patient demographics, AVM angioarchitecture, management modality and outcomes was collected and analyzed.

    Results: Thirty patients met the inclusion criteria, 19 females and 11 males. Average age at presentation was 72.75 years (range: 65 – 87). 37% of the patients presented with a ruptured AVM. Average age of patients presenting with hemorrhage was similar to the patients presenting with no hemorrhage (72.7 vs 72.8 years). AVM was located in infratentorial location in 15 patients (50%). Most common Spetzler-Martin grade was 2. Mean preoperative mRS was 1.18 (treated pts, 1.43; untreated pts, 1.19). Eleven patients underwent microsurgical resection of AVM, 4 underwent SRS, none underwent embolization and 15 did not receive any treatment. Of the patients that received treatment, 10 got better or remained the same (71%). Mean follow up duration was 4.1 years. Mean postoperative mRS was 1.5 (treated patients, 1.5; untreated pts, 1.67). AVM obliteration was achieved in all patients that underwent treatment.

    Conclusions: This represents the largest cohort of patients aged > 65 years harboring brain AVMs and shows that multimodality treatment of ruptured and unruptured AVMs in this population can be undertaken with a favorable risk-safety profile. Studies with larger data cohorts are needed to confirm these findings.

    Patient Care: This study helps us recognize that even patients aged 65 and more should be offered treatment for ruptured and unruptured AVMs unless precluded by major medical co-morbidities.

    Learning Objectives: By the conclusion of this session, participants should be able to recognize that advanced age should not be considered a limiting factor when managing AVMs in elderly population.


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