Intracranial Arteriovenous Malformations

Medical Attention ◽

Radiographic Findings ◽

Intracranial Vascular Malformation ◽

Arteries And Veins

Intracranial arteriovenous malformations (AVMs) are a type of intracranial vascular malformation that consists of an abnormal connection of arteries and veins without intervening capillary beds. AVMs may come to medical attention because of seizure, intracranial hemorrhage, or incidental radiographic findings in a patient undergoing brain imaging for a different indication. This chapter focuses on the epidemiology, natural history, diagnosis, and management of intracranial AVMs.

Posterior fossa arteriovenous malformations

Neurosurgical FOCUS ◽

10.3171/2009.2.focus0914 ◽

2009 ◽

Vol 26 (5) ◽

pp. E12 ◽

Cited By ~ 69

Author(s):

Omar M. Arnaout ◽

Bradley A. Gross ◽

Christopher S. Eddleman ◽

Bernard R. Bendok ◽

Christopher C. Getch ◽

...

Keyword(s):

Natural History ◽

Posterior Fossa ◽

Intracranial Hemorrhage ◽

Therapeutic Options ◽

Aggressive Treatment

Arteriovenous malformations (AVMs) of the posterior fossa are complex neurovascular lesions that are less common than their supratentorial counterparts, accounting for < 15% of all AVMs. The majority of patients with these lesions present with intracranial hemorrhage, a factor that has been consistently shown to increase one's risk for subsequent bleeding. Studies have additionally shown a posterior fossa or deep AVM location to portend a more aggressive natural history. The authors reviewed the literature on posterior fossa AVMs, finding their annual rupture rates to be as high as 11.6%, an important factor that underscores the importance of aggressive treatment of lesions amenable to intervention as therapeutic options and results continue to improve.

Intracranial Arteriovenous Malformations Associated with Aneurysms

Neurosurgery ◽

10.1227/00006123-198601000-00006 ◽

1986 ◽

Vol 18 (1) ◽

pp. 29-35 ◽

Cited By ~ 138

Author(s):

Hunt Batjer ◽

Richard A. Suss ◽

Duke Samson

Keyword(s):

Intracranial Aneurysm ◽

Arteriovenous Malformation ◽

Intracranial Hemorrhage ◽

Surgical Care ◽

Feeding System ◽

Hemodynamic Changes ◽

Feeding Vessels ◽

Microsurgical Resection

Abstract The presence of intracranial aneurysm in association with arteriovenous malformation has been well documented. Aneurysms have been described in typical proximal sites along the feeding system to the arteriovenous malformation, in abnormal distal locations along feeding vessels, and in sites remote and apparently hemodynamically unrelated to the arteriovenous malformation. Little attention has been focused on the most appropriate medical and surgical care of patients harboring these lesions. Since 1977, 22 patients with this combination of lesions have been evaluated at our institution. Nine patients (41%) presented after intracranial hemorrhage. The remaining 13 patients were investigated because of seizures in 5 patients (23%), headaches in 4 patients (18%), and progressive ischemia in 4 patients (18%). Among the patients suffering intracranial hemorrhage, 78% had bled from an aneurysm, with 22% having hemorrhaged from their arteriovenous malformation. All 7 of the patients who suffered aneurysmal hemorrhage bled from atypical distal aneurysms on major feeding vessels. Our experience and that of others has led us to believe that the safest approach to patients with this combination of lesions is to treat the aneurysm before microsurgical resection of the associated arteriovenous malformation. Hemodynamic changes associated with the abrupt elimination of an arteriovenous malformation may place associated aneurysms at immediate risk.

Natural History of Arteriovenous Malformations of the Brain: A Clinical Study

Neurosurgery ◽

10.1227/00006123-198411000-00003 ◽

1984 ◽

Vol 15 (5) ◽

pp. 658-662 ◽

Cited By ~ 285

Author(s):

Dan Fults ◽

David L. Kelly

Keyword(s):

Clinical Study ◽

Natural History ◽

Posterior Fossa ◽

Recurrent Hemorrhage ◽

History Of ◽

The Brain

Abstract The natural history of intracranial arteriovenous malformations (AVMs) was studied in 131 patients. The 83 patients managed nonsurgically and the 48 patients treated surgically were followed for an average of 8 years. Hemorrhage occurred in 61.8% of all patients. A second hemorrhage occurred in 67.4% of the survivors of the first hemorrhage. The mortality associated with recurrent hemorrhage did not increase significantly with successive episodes of hemorrhage. The rate of rebleeding was 17.9%/year initially, but declined to 3%/year after 5 years and then to 2%/year after 10 years. Among patients treated nonsurgically, the prognosis was more favorable for patients presenting with seizures than for patients presenting with hemorrhage. Patients in the seizure group had a 26.9% incidence of hemorrhage causing an 11.6% mortality; 40.5% of the patients in the hemorrhage group died. The prognosis was poor for patients with posterior fossa A V Ms; the mortality was 66.7% with the first hemorrhage. Recurrent posterior fossa hemorrhage was the rule in survivors, and most of those hemorrhages were fatal. The prognosis for children with AVMs was no different from that for adults.

The natural history of unruptured intracranial arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/jns.1988.68.3.0352 ◽

1988 ◽

Vol 68 (3) ◽

pp. 352-357 ◽

Cited By ~ 501

Author(s):

Robert D. Brown ◽

David O. Wiebers ◽

Glenn Forbes ◽

W. Michael O'Fallon ◽

David G. Piepgras ◽

...

Keyword(s):

Natural History ◽

Aneurysm Rupture ◽

Content Type ◽

Risk Of Death ◽

History Of ◽

Risk Of Hemorrhage

✓ The authors conducted a long-term follow-up study of 168 patients to define the natural history of clinically unruptured intracranial arteriovenous malformations (AVM's). Charts of patients seen at the Mayo Clinic between 1974 and 1985 were reviewed. Follow-up information was obtained on 166 patients until death, surgery, or other intervention, or for at least 4 years after diagnosis (mean follow-up time 8.2 years). All available cerebral arteriograms and computerized tomography scans of the head were reviewed. Intracranial hemorrhage occurred in 31 patients (18%), due to AVM rupture in 29 and secondary to AVM or aneurysm rupture in two. The mean risk of hemorrhage was 2.2% per year, and the observed annual rates of hemorrhage increased over time. The risk of death from rupture was 29%, and 23% of survivors had significant long-term morbidity. The size of the AVM and the presence of treated or untreated hypertension were of no value in predicting rupture.