Introduction Occipital arteriovenous malformations (AVM) carry a high risk of post-operative morbidity because of their anatomic relation to the visual cortex and optic radiations. We report our single-center experience with occipital AVMs, most of which were treated endovascularly, with a special interest for visual impairment after treatment.
Materials and methods From a prospectively collected database, we reviewed the clinical and radiological data of all patients with AVM involving the occipital lobe managed between 1997 and 2017.
The lesions were classified according to the modified Spetzler-Martin grading system. The extension of the nidus to the primary visual cortex was assessed and correlated to the pre- and post-intervention visual symptomatology. Modified Rankin Scale and visual fields were assessed pre and post-treatment and at the last follow-up.
Results Eighty-three patients (47 males [56,6%]) with an occipital AVM were included in the study. Mean age at presentation was 33.5 ± 15.0 years old (min-max = 7–76). Thirty-four patients (40,9%) presented with hemorrhage related to the AVM. Fifty-eight patients (69.8%) underwent endovascular treatment alone, 19 (22,9%) embolization and surgery, 3 (3,6%) embolization and radiosurgery and 3 (3,6%) were conservatively managed.
A complete obliteration of the AVM was achieved in 49 patients (59%). The mean follow-up duration after treatment was 19,4 months (max. 330 months). A post-treatment aggravation of the visual field was found in 3 patients (23%) for ruptured AVMs and in 21 patients (45,6%) for unruptured AVMs (figure 1) (figure 2).
Morbidity rate was 3.75% and mortality rate was 2.5%.
Conclusion Endovascular treatment of occipital AVM (± combined with surgery) might be a feasible technique. However the complication rate (especially regarding visual functions) remains non-negligible.
Disclosures S. Smajda: None. G. Ciccio’: None. R. Fahed: None. T. Robert: None. R. Blanc: None. M. Piotin: None.
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