Maltese Study of Intracranial Vascular Malformations

Authors: Theresia Dalli, Charmaine Chircop, Maria Mallia

Corresponding: Theresia Dalli (

Keywords: intracranial vascular malformations, arteriovenous malformation, cavernoma, cavernous malformation


Issue: Xjenza Online Vol. 6 Iss. 1 - September 2018

Intracranial vascular malformations (IVMs) are responsible for 49% of spontaneous intraparen- chymal brain haemorrhage in patients under 40 years of age. IVMs may cause recurrent intracranial bleeds, focal neurological de cits, seizures and chronic disabil- ity. The aim was to study the incidence of arterio-venous malformations (AVMs) and cerebral cavernous malform- ations (CCMs) in the Maltese population, assess mode of presentation, patterns of interventions, outcomes and follow-up of the lesions. A word search through the ra- diology information system was carried out, identifying cases of IVMs between 2008 and 2016 at Mater Dei Hos- pital. Brain or dural AVM, carotid-cavernous stulae and CCM were included in the study. A participant was identi ed as the incident" case at the time of the rst diagnostic image. Interventions, follow-ups and com- plications were noted. 47 patients had AVM and 35 had CCM. The majority of patients with AVM presented with headaches. MRI was the prevalent imaging mod- ality used at diagnosis. 42.6% of patients received ra- diosurgery. Haemorrhage was the commonest complic- ation. 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 signi cant morbid- ity 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 clini- cians on the evidence-based management of IVMs.

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