Intracranial Arteriovenous Malformation: Relationships between Clinical and Radiographic Factors and Ipsilateral Steal Severity

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Abstract
Intracranial arteriovenous malformations (AVMs) are high flow shunts that may jeopardize the perfusion of adjacent tissue. Clinical and radiographic data from 62 patients were analyzed to determine their relationship to the severity of steal measured by single photon emission computed tomography (SPECT). The ipsilateral steal index [Steal(i)] was determined by dividing regional cerebral blood flow (rCBF) values within hand-drawn regions of hypoperfusion in the ipsilateral hemisphere by total brain flow, which was calculated as the average rCBF of each hemisphere. Of the patients, 40% were less than 30 years of age, 45% were 30 to 50 years old, and 15% were over 50. Forty-eight per cent presented with hemorrhage and 34% presented with progressive deficits. There was angiographic steal in 37%, and postoperative hyperemic complications developed in 21%. All patients had ipsilateral regions of hypoperfusion. The ISteal(i) was < 0.7 in 23 (37%), 0.7 to 0.8 in 20 (32%), and > 0.8 in 19 (31%). The ISteal(i) was significantly less severe in the patients over 50; 78% of these patients had an ISteal(i) of > 0.8 (P < 0.01). A history of hemorrhage was associated with less severe steal than that in patients who had not bled (P = 0.088). Patients presenting with a history of progressive deficits had increased severity of steal compared with those without progressive deficits (P < 0.05). A trend toward decreased severity of steal was noted in patients with unfavorable outcomes. The size of the AVM, the presence of angiographic steal, the number of major feeding vessels, and the recruitment of perforating vessels seemed to have no relationship to steal severity. Preoperative SPECT measurements can accurately quantitate flow asymmetry and hypoperfusion and potentially assess the impact of treatment on cerebral hemodynamics.