Saturday, November 22, 2008

Got One.... More me... I guess....

Management and clinical outcome of posterior fossa arteriovenous malformations – report on a single center 15 years experience

Leodante B da Costa Jr1*, Laurent Thines 1, Amir R. Dehdashti 1, Michael C. Wallace 1, Robert A Willinsky 1, Michael Schwartz 1, Michael Tymianski 1 and Karel Terbrugge 1

1 University of Toronto, Canada

* To whom correspondence should be addressed. E-mail:

Objectives: Posterior fossa brain arteriovenous malformations (PFbAVMs) are rare lesions. Management is complicated by eloquence of adjacent neurological structures, multimodality treatment is often necessary and obliteration not always possible. We describe our 15-year experience in the management of posterior fossa brain AVMs with focus on clinical outcome.

Methods: From 1989 to 2004, prospectively collected information on 106 patients with diagnosis of a PFbAVMs was obtained. Clinical and angioarchitectural characteristics, management options and complications are described and reviewed to evaluate their impact on final outcome as measured by mRS (modified Rankin Score).

Results: Ninety-eight patients were followed for an average of 3.3 years (1-14.6). Male to female ratio was 1:1. Ninety-five out of 98 patients (96.9%) were symptomatic at presentation, with 61 (62.2%) intracranial hemorrhages. Sixty-two patients were treated (46 cerebellar, 16 brainstem). Ten hemorrhages occurred in follow up (4.1%/year). Modified Rankin Score was obtained in 62 patients and was classified as low (good, mRS ≤ 2) or high (poor, mRS ≥ 3). Hemorrhage was the only predictor of poor mRS at presentation (p=0.0229). A poor clinical outcome was correlated with the presence of AA (p=0.0276), a poor initial mRS (p<0.0001)> of treatments needed (p=0.0434). Patients were significantly more likely to improve than to deteriorate over time (p=0.0201).

Conclusion: The final clinical outcome in PFbAVMs relates directly with the presence of associated aneurysms, number of treatments needed to occlude the AVM and mRS at presentation. Overall, patients are more likely to improve than to deteriorate with management, and expedite, more definitive treatment is probable a better choice in patients with good mRS after hemorrhage.

Well today is pretty blaaa... if you know what i mean.
I woke up, just to go back to bed. Slept 2 hours.
I got something to say... I just need to say, my Dr. is a nice guy, and I agree with most that he has to say.... but when he gave me 6 months to recover, I say balls to that!
Look at my typing at 6 months... I was a fuggnig mess.
Don't get me wrong... I am still a mess, but to compare to me at 6 months , I am getting along just fine now.

So make a donation or don't.
But common along, help me say it... Dr. More... you are wrong.

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