The natural history of unruptured intracranial arteriovenous malformations

✓ 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.

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Long-term natural history of hemorrhagic type moyamoya disease in 42 patients

Journal of Neurosurgery ◽

10.3171/jns.2000.93.6.0976 ◽

2000 ◽

Vol 93 (6) ◽

pp. 976-980 ◽

Cited By ~ 132

Author(s):

Eiichi Kobayashi ◽

Naokatsu Saeki ◽

Hiromichi Oishi ◽

Shinji Hirai ◽

Akira Yamaura

Keyword(s):

Risk Factors ◽

Natural History ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Bleeding Episode ◽

Content Type ◽

History Of ◽

Fine Print

Object. The purpose of this study was to delineate the long-term natural history of hemorrhagic moyamoya disease (MMD).Methods. A retrospective review was conducted among 42 patients suffering from hemorrhagic MMD who had been treated conservatively without bypass surgery. The group included four patients who had undergone indirect bypass surgery after an episode of rebleeding. The follow-up period averaged 80.6 months. The clinical features of the first bleeding episode and repeated bleeding episodes were analyzed to determine the risk factors of rebleeding and poor outcome.Intraventricular hemorrhage with or without intracerebral hemorrhage was a dominant finding on computerized tomography scans during the first bleeding episode in 29 cases (69%). During the follow-up period, 14 patients experienced a second episode of bleeding, which occurred 10 years or longer after the original hemorrhage in five cases (35.7%). The annual rebleeding rate was 7.09%/person/year. The second bleeding episode was characterized by a change in which hemisphere bleeding occurred in three cases (21.4%) and by the type of bleeding in seven cases (50%). After rebleeding the rate of good recovery fell from 45.5% to 21.4% and the mortality rate rose from 6.8% to 28.6%. Rebleeding and patient age were statistically significant risk factors of poor outcome. All four patients in whom there was indirect revascularization after the second bleeding episode experienced a repeated bleeding episode within 8 years.Conclusions. The occurrence of rebleeding a long time after the first hemorrhagic episode was not uncommon. Furthermore, the change in which hemisphere and the type of bleeding that occurred after the first episode suggested the difficulty encountered in the prevention of repeated hemorrhage.

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The natural history of aneurysms and arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/jns.1985.62.3.0321 ◽

1985 ◽

Vol 62 (3) ◽

pp. 321-323 ◽

Cited By ~ 214

Author(s):

John A. Jane ◽

Neal F. Kassell ◽

James C. Torner ◽

H. Richard Winn

Keyword(s):

Subarachnoid Hemorrhage ◽

Natural History ◽

Arteriovenous Malformations ◽

Anterior Cerebral Artery ◽

Unknown Etiology ◽

Content Type ◽

Ruptured Aneurysms ◽

History Of ◽

Fine Print

✓ The authors summarize the findings of previous studies relating to the natural history of aneurysms and arteriovenous malformations (AVM's). Ruptured aneurysms have their highest rate of rebleeding on Day 1, and at least 50% will rebleed during the 6 months after the first hemorrhage. Thereafter, the rate drops to at least 3% a year. This is the same rate as seen in anterior and posterior communicating artery aneurysms treated by anterior cerebral artery clipping and carotid ligation; these operations provide immediate protection but do not result in long-term diminution of the risk of rebleeding. Patients with unruptured incidental and unruptured multiple aneurysms rebleed at a rate of 1% per year, as do patients with subarachnoid hemorrhage of unknown etiology. The risk of rebleeding for AVM's is 3% a year.

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Deep arteriovenous malformations of the basal ganglia and thalamus: natural history

Journal of Neurosurgery ◽

10.3171/jns.2003.98.4.0747 ◽

2003 ◽

Vol 98 (4) ◽

pp. 747-750 ◽

Cited By ~ 70

Author(s):

Ian G. Fleetwood ◽

Mary L. Marcellus ◽

Richard P. Levy ◽

Michael P. Marks ◽

Gary K. Steinberg

Keyword(s):

Basal Ganglia ◽

Natural History ◽

Arteriovenous Malformations ◽

Venous Drainage ◽

Neurological Injury ◽

Content Type ◽

Hemorrhagic Event ◽

History Of ◽

Risk Of Hemorrhage ◽

Fine Print

Object. Patients with arteriovenous malformations (AVMs) in a deep location and with deep venous drainage are thought to be at higher risk for hemorrhage than those with AVMs in other locations. Despite this, the natural history of AVMs of the basal ganglia and thalamus has not been well studied. Methods. The authors retrospectively evaluated a cohort of 96 patients with AVMs in the basal ganglia and thalamus with respect to the tendency of these lesions to hemorrhage between the time of detection and their eventual successful management. The 96 patients studied had a mean age of 22.7 years at diagnosis, and 51% were male. Intracranial hemorrhage (ICH) was the event leading to clinical detection in 69 patients (71.9%), and 85.5% of these patients were left with hemiparesis. After diagnosis, 25 patients bled a total of 49 times. The cumulative clinical follow up after detection but before surgical management was 500.2 patient-years. The risk of hemorrhage after detection of an AVM of the basal ganglia or thalamus was 9.8% per patient-year. Conclusions. The rate of ICH in patients with AVMs of the basal ganglia or thalamus (9.8%/year) is much higher than the rate in patients with AVMs in other locations (2–4%/year). The risk of incurring a neurological deficit with each hemorrhagic event is high. Treatment of these patients at specialized centers is recommended to prevent neurological injury from a spontaneous ICH.

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Treatment of brain arteriovenous malformations by embolization and radiosurgery

Journal of Neurosurgery ◽

10.3171/jns.1996.85.1.0019 ◽

1996 ◽

Vol 85 (1) ◽

pp. 19-28 ◽

Cited By ~ 285

Author(s):

Y. Pierre Gobin ◽

Alexandre Laurent ◽

Louis Merienne ◽

Maurice Schlienger ◽

Armand Aymard ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Morbidity Rate ◽

Total Occlusion ◽

Content Type ◽

Brain Arteriovenous Malformations ◽

History Of ◽

Grade Ii ◽

Risk Of Hemorrhage ◽

Grade Iii

✓ Embolization was used to reduce the size of brain arteriovenous malformations (AVMs) prior to radiosurgical treatment in 125 patients who were poor surgical candidates or had refused surgery. Of these patients, 81% had suffered hemorrhage, and 22.4% had undergone treatment at another institution. According to the Spetzler—Martin scale, the AVMs were Grade II in 9.6%, Grade III in 31.2%, Grade IV in 30.4%, and Grades V to VI in 28.8% of the cases. Most embolizations were performed using cyanoacrylate delivered by flow-guided microcatheters. Radiosurgery was performed using a linear accelerator in 62 patients treated by the authors, and 34 patients were treated at other institutions using various methods. Embolization produced total occlusion in 11.2% of AVMs and reduced 76% of AVMs enough to allow radiosurgery. Radiosurgery produced total occlusion in 65% of the partially embolized AVMs (79% when the residual nidus was < 2 cm in diameter). Embolizations resulted in a mortality rate of 1.6% and a morbidity rate of 12.8%. No complications were associated with radiosurgery. The hemorrhage rate for partially embolized AVMs was 3% per year. No patient with a completely occluded AVM experienced rehemorrhage. Angiographic follow-up review of AVMs embolized with cyanoacrylate demonstrated a 11.8% revascularization rate, occurring within 1 year. It is concluded that after partial embolization with cyanoacrylate, the risk of hemorrhage from the residual nidus is comparable to the natural history of AVMs and that the residual nidus can be irradiated with results almost as good as for a native AVM of the same size.

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The natural history of pituitary apoplexy: long term follow-up study

Endocrine Abstracts ◽

10.1530/endoabs.65.p301 ◽

2019 ◽

Author(s):

Ayesha Shaikh ◽

Natasha Shrikrishnapalasuriyar ◽

Giselle Sharaf ◽

David Price ◽

Maneesh Udiawar ◽

...

Keyword(s):

Natural History ◽

Pituitary Apoplexy ◽

Follow Up Study ◽

Long Term Follow Up ◽

History Of

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Faculty Opinions recommendation of Natural history of imatinib-naive GISTs: a retrospective analysis of 929 cases with long-term follow-up and development of a survival nomogram based on mitotic index and size as continuous variables.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13356067.14726207 ◽

2011 ◽

Author(s):

Richard Riedel

Keyword(s):

Natural History ◽

Retrospective Analysis ◽

Mitotic Index ◽

Continuous Variables ◽

Long Term Follow Up ◽

History Of

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ID: 3524040 THE NATURAL HISTORY OF AMPULLARY ADENOMAS IN FAMILIAL ADENOMATOUS POLYPOSIS SYNDROME: LONG-TERM FOLLOW-UP

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2021.03.890 ◽

2021 ◽

Vol 93 (6) ◽

pp. AB350

Author(s):

Achintya D. Singh ◽

Amit Bhatt ◽

Abel Joseph ◽

Neal Mehta ◽

Gautam N. Mankaney ◽

...

Keyword(s):

Familial Adenomatous Polyposis ◽

Natural History ◽

Adenomatous Polyposis ◽

Polyposis Syndrome ◽

Long Term Follow Up ◽

History Of

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Natural history of branch duct intraductal papillary-mucinous neoplasms of the pancreas without mural nodules: long-term follow-up results

Gut ◽

10.1136/gut.2007.129684 ◽

2008 ◽

Vol 57 (3) ◽

pp. 339-343 ◽

Cited By ~ 176

Author(s):

S Tanno ◽

Y Nakano ◽

T Nishikawa ◽

K Nakamura ◽

J Sasajima ◽

...

Keyword(s):

Natural History ◽

Intraductal Papillary Mucinous Neoplasms ◽

Branch Duct ◽

Mucinous Neoplasms ◽

Long Term Follow Up ◽

History Of ◽

Mural Nodules

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The long-term outcomes of radiosurgery for arteriovenous malformations in pediatric and adolescent populations

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.1.peds14407 ◽

2015 ◽

Vol 16 (2) ◽

pp. 222-231 ◽

Cited By ~ 29

Author(s):

Shunya Hanakita ◽

Tomoyuki Koga ◽

Masahiro Shin ◽

Hiroshi Igaki ◽

Nobuhito Saito

Keyword(s):

Adverse Events ◽

Arteriovenous Malformations ◽

Therapeutic Option ◽

Long Term Outcomes ◽

Bleeding Rate ◽

Study Institute ◽

Delayed Complications ◽

Risk Of Hemorrhage

OBJECT Although stereotactic radiosurgery (SRS) has been accepted as a therapeutic option for arteriovenous malformations (AVMs) in children and adolescents, substantial data are still lacking regarding the outcomes of SRS for AVMs in this age group, especially long-term complications. This study aimed to clarify the long-term outcomes of SRS for the treatment of AVM in pediatric patients aged ≤ 18 years. METHODS Outcomes of 116 patients who were aged 4–18 years when they underwent SRS between 1990 and 2009 at the study institute were analyzed retrospectively. RESULTS The median follow-up period after SRS was 100 months, with 6 patients followed up for more than 20 years. Actuarial obliteration rates at 3 and 5 years after SRS were 68% and 88%, respectively. Five hemorrhages occurred in 851 patient-years of follow-up. The annual bleeding rate after SRS before obliteration was calculated as 1.3%, which decreased to 0.2% after obliteration. Shorter maximum nidus diameter (p = 0.02) and higher margin dose (p = 0.03) were associated with a higher obliteration rate. Ten patients experienced adverse events after SRS. Of them, 4 patients presented with delayed complications years after SRS (range 9–20 years after SRS). CONCLUSIONS SRS can reduce the risk of hemorrhage in pediatric and adolescent AVMs, with an acceptable risk of complications in the long term. However, adverse events such as expanding hematoma and radiation necrosis that can occur after substantial follow-up should be taken into account at the time that treatment decisions are made and informed consent is obtained.

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