Prevalence of angiographically negative vascular malformation in operated patients with subcortical hematomas

Abstract

The results of microsurgical treatment of 539 patients with subcortical ICH operated in the department of emergency neurosurgery of the N. V. Sklifosovsky Research Institute for Emergency Medicine were analyzed. The incidence of angiographically negative AVM was 10.9 % (59 patients). In 49 patients (9 %), AVM was found intraoperatively and confirmed histologically, in another 10 patients (1.9 %), malformation was detected only during histological examination of blood clotts. The average age of these patients was 43.3 years, the presence of arterial hypertension (AH) was noted in 40 % of cases. Intraoperative bleeding from an angiographically negative AVM occurred in 6 patients (1.1 %). In the presence of characteristic CT signs of ICH due to AVM rupture, as well as taking into account the young age of the patient (up to 50 years) and the absence of hypertension in the anamnesis, even if AVM is excluded by the results of digital substractional angiography (DSA), it is advisable to perform an open intervention with subcortical ICH. On the contrary, in elderly people with a history of hypertension and negative DSA data, endoscopic aspiration of ICH is possible.