Management and clinical outcome of posterior fossa arteriovenous malformations: report on a single-centre 15-year experience

Costa, Leodante da; Thines, L.; Dehdashti, Amir R.; Wallace, M. Christopher; Willinsky, Robert A.; Tymianski, Michael; Schwartz, Michael L.; Brugge, Karel G. ter

doi:10.1136/jnnp.2008.152710

Cited by 90 publications

(72 citation statements)

References 35 publications

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“…7 In particular, infratentorial AVMs have been shown to have a higher incidence of associated IAs, hemorrhagic presentation, and unfavorable outcomes. 3,4 In a recent study, AVMs supplied by the posterior circulation, of which 72% were perfusing supratentorial malformations, were found to be more commonly associated with IAs. This finding was suggested to be the result of the interaction between the increased hemodynamic stress due to the presence of the malformation itself and greater peak systolic pressure within the vertebrobasilar system, compared with the anterior circulation.…”

Section: Pathogenesis and Demographicsmentioning

confidence: 99%

“…14,20 It is commonly cited that the presence of IAs in patients with AVMs is associated with an increased risk of hemorrhage. 4,6,7,14,[21][22][23] In their meta-analysis, Gross 7,20 while others have found that distal flow-related and intranidal aneurysms that are immediately adjacent to the site of arteriovenous shunting may be more prone to rupture, given the higher flow, pressure, and shear stress on the vessel wall. 8 Finally, the presence of venous ectasia has been found to be inversely related to the risk of hemorrhage, probably reflecting a protective adaptive mechanism that may become more prevalent in older patients.…”

Section: Natural Historymentioning

confidence: 99%

“…Intracranial aneurysms may confer a higher risk of hemorrhage at presentation and of rehemorrhage in patients with AVMs and therefore may be associated with a more unfavorable natural history. [1][2][3][4][5][6] In this report, we review the classification and radiology of AVM-associated IAs and discuss their clinical significance and implications for treatment.…”

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confidence: 99%

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Aneurysms Associated with Brain Arteriovenous Malformations

Rammos¹,

Gardenghi

Bortolotti³

et al. 2016

AJNR Am J Neuroradiol

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SUMMARY:Brain arteriovenous malformations are frequently associated with the presence of intracranial aneurysms at a higher-thanexpected incidence based on the frequency of each lesion individually. The identification of intracranial aneurysms in association with AVMs has increased due to improvement in diagnostic techniques, particularly 3D and superselective conventional angiography. Intracranial aneurysms may confer a higher risk of hemorrhage at presentation and of rehemorrhage in patients with AVMs and therefore may be associated with a more unfavorable natural history. The association of AVMs and intracranial aneurysms poses important therapeutic challenges for practicing neurosurgeons, neurologists, and neurointerventional radiologists. In this report, we review the classification and radiology of AVM-associated intracranial aneurysms and discuss their clinical significance and implications for treatment. ABBREVIATION: IA ϭ intracranial aneurysm

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Section: Pathogenesis and Demographicsmentioning

confidence: 99%

Section: Natural Historymentioning

confidence: 99%

mentioning

confidence: 99%

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Aneurysms Associated with Brain Arteriovenous Malformations

Rammos¹,

Gardenghi

Bortolotti³

et al. 2016

AJNR Am J Neuroradiol

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“…[9][10][11] Some authors have previously noticed that prenidal aneurysm ruptures were frequent when AVMs were located in the posterior fossa. 2,8,12 We sought to confirm, in a series of cases involving patients with AVMs who were treated at our institution, that patients with posterior fossa AVMs frequently present with hemorrhage associated with prenidal aneurysm ruptures. We also aimed to review the outcome for patients presenting with such ruptures who were treated by endovascular means.…”

mentioning

confidence: 99%

Association between posterior fossa arteriovenous malformations and prenidal aneurysm rupture: potential impact on management

Kouznetsov¹,

Weill²,

Ghostine³

et al. 2014

FOC

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Object In patients with posterior fossa arteriovenous malformations (AVMs) who present with hemorrhage, feeding artery aneurysms are often the source of bleeding. The aim of this study was to evaluate the relative proportions of cases of infra- and supratentorial AVMs in which patients presented with prenidal aneurysm rupture. The management and outcome of 9 cases of posterior fossa AVMs associated with prenidal aneurysm rupture are presented. Methods The authors retrospectively reviewed 233 consecutive AVM cases involving patients treated at their institution between April 2001 and August 2012. Patients with a prenidal aneurysm as the cause of the hemorrhage were identified. The frequencies of prenidal aneurysm-related ruptures were compared in cases of supra- and infratentorial AVMs. Management and clinical outcome (modified Rankin Scale [mRS] score) of patients with posterior fossa AVMs treated for ruptured prenidal aneurysms were recorded. Results Of 233 AVMs, 25 (11%) were in the posterior fossa, and in 22 (88%) of these cases, the patients presented with hemorrhage, including 9 patients (41%) who presented with hemorrhage due to prenidal aneurysm rupture. Of 208 patients with supratentorial AVMs, 107 (51%) presented with hemorrhage, including 5 patients (4.7%) in whom the hemorrhage was associated with a prenidal aneurysm (p < 0.01). All 9 patients with posterior fossa AVMs and prenidal aneurysm rupture were treated with early embolization of the offending aneurysm. There was no early rebleeding or clinical complication related to this approach. At the end of follow-up (mean 46.8 months), 2 patients had an mRS score of 0, 1 had a score of 1, 3 had a score of 2, 2 patients were dead (mRS score of 6), and 1 patient was lost to follow-up. Conclusions Posterior fossa AVM hemorrhages are frequently associated with prenidal arterial aneurysms. Urgent endovascular treatment of the aneurysm was effective in this case series.

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“…Specifically, saccular and fusiform aneurysms arising along the direct course of arterial supply to the AVM are considered “flow-related” [4]. Coexisting aneurysms have been reported in up to 16.7% of cerebral AVMs [5,6,7,8,9,10]. The presence of coexisting unruptured aneurysms is associated with an increased risk of intracranial hemorrhage, with a published risk of 7% per year as compared to patients with AVMs alone with a risk of 3% [5].…”

Section: Introductionmentioning

confidence: 99%

Pipeline Flex Embolization of Flow-Related Aneurysms Associated with Arteriovenous Malformations: A Case Report

et al. 2018

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Background: An estimated 0.1% of the population harbors brain arteriovenous malformations (AVMs). Diagnosis and workup of AVMs include thorough evaluation for characterization of AVM angioarchitecture and careful assessment for concomitant aneurysms. The presence of coexisting aneurysms is associated with an increased risk of intracranial hemorrhage, with a published risk of 7% per year compared to patients with AVMs alone with a risk of 3%. Comprehensive AVM management requires recognition of concomitant aneurysms and prioritizes treatment strategies to mitigate the aggregate risk of intracranial hemorrhage associated with AVM rupture in patients with coexisting aneurysms. Endovascular treatment of these flow-related aneurysms can offer a cure, while avoiding open surgery. Successful flow-diverting embolization techniques, efficacy, and outcomes have been previously described for a variety of aneurysm types and locations. However, use of a flow diverter has not been previously described for the treatment of high-flow aneurysms on AVM-feeding vessels. Case Presentation: We report 2 cases of large AVMs within eloquent cortex associated with flow-related aneurysms in patients presenting initially with suspected intracerebral hemorrhage secondary to AVM rupture. Discussion: No consensus currently exists to guide treatment of intracranial aneurysms associated with AVMs. Surgical management addressed AVM embolization initially, as the vasculopathology with the highest rupture risk. Subsequently, Pipeline embolization of the associated aneurysms with adequate antiplatelet treatment was performed before scheduled radiosurgery to decrease the risk of AVM rupture or rebleed. This represents a novel and promising use of the Pipeline Embolization Device. Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.

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Management and clinical outcome of posterior fossa arteriovenous malformations: report on a single-centre 15-year experience

Cited by 90 publications

References 35 publications

Aneurysms Associated with Brain Arteriovenous Malformations

Aneurysms Associated with Brain Arteriovenous Malformations

Association between posterior fossa arteriovenous malformations and prenidal aneurysm rupture: potential impact on management

Pipeline Flex Embolization of Flow-Related Aneurysms Associated with Arteriovenous Malformations: A Case Report

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