Maltese study of intracranial vascular malformations

Abstract

Intracranial vascular malformations (IVMs) are responsible for 49% of spontaneous intraparenchymal brain haemorrhage in patients under 40 years of age. IVMs may cause recurrent intracranial bleeds, focal neurological deficits, seizures and chronic disability. The aim was to study the incidence of arterio-venous malformations (AVMs) and cerebral cavernous malformations (CCMs) in the Maltese population, assess mode of presentation, patterns of interventions, outcomes and follow-up of the lesions. A word search through the radiology information system was carried out, identifying cases of IVMs between 2008 and 2016 at Mater Dei Hospital. Brain or dural AVM, carotid-cavernous fistulae and CCM were included in the study. A participant was identified as the “incident” case at the time of the first diagnostic image. Interventions, follow-ups and complications were noted. 47 patients had AVM and 35 had CCM. The majority of patients with AVM presented with headaches. MRI was the prevalent imaging modality used at diagnosis. 42.6% of patients received radiosurgery. Haemorrhage was the commonest complication. In the CCM group, seizures and focal signs were common presenting symptoms. 65.7% of patients with a CCM were followed-up with further imaging within one year of diagnosis. The majority of patients received no intervention. IVMs may cause significant morbidity in patients and timely recognition is essential. The risk of haemorrhage in patients with AVMs is 1–4% per annum and this risk directs management. Presently, decisions regarding CCMs are made on a case-by-case basis. There is a need for guidelines, to help direct clinicians on the evidence-based management of IVMs.