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Clinical Relevance of Associated Aneurysms with Arteriovenous Malformations of the Posterior Fossa

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Trends in Neurovascular Surgery

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 112))

Abstract

The aim of this study was to determine the frequency of aneurysms associated with arteriovenous malformations (AVMs) of the posterior fossa and their relation to hemorrhagic presentation in comparison to supratentorial AVMs. We performed a retrospective analysis of 474 patients with intracranial AVMs treated in our center from 1990 to 2010. Patients were analyzed for AVM size, drainage type and their clinical course with focus on vessel anomalies including AVM-associated aneurysms. Seventeen (30%) of 57 posterior fossa AVMs versus 46 (11%) of 417 supratentorial AVMs were associated with aneurysms. In six (10.5%) versus seven (1.7%) patients, respectively, flow-associated aneurysms were the source of hemorrhage. Infratentorial location of an AVM was a significant risk factor for the incidence (p < 0.001) and rupture (p < 0.001) of AVM-associated aneurysms. Feeding artery aneurysms in particular represented a risk factor for hemorrhage in the overall group of AVM patients, independently of the location (p < 0.001). The majority of patients with a posterior fossa AVM were treated by combined embolization and surgical removal within one procedure (n = 33, 58%). Feeding artery aneurysms were excluded by endovascular coiling or surgical clipping whenever feasible. Overall treatment-associated permanent morbidity in the subgroup of posterior fossa AVMs was 11% (n = 6) and mortality 4% (n = 2). Posterior fossa AVMs display a significantly higher frequency of associated aneurysms of the adjacent vessels that are correlated to the high bleeding rate compared to AVMs of the supratentorial compartment. We therefore recommend aggressive AVM treatment including the exclusion of associated aneurysms as a minimal therapeutic goal whenever possible.

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References

  1. Arnaout OM, Gross BA, Eddleman CS, Bendok BR, Getch CC, Batjer HH (2009) Posterior fossa arteriovenous malformations. Neurosurg Focus 26:E12

    Article  PubMed  Google Scholar 

  2. Choi JH, Mohr JP (2005) Brain arteriovenous malformations in adults. Lancet Neurol 4:299–308

    Article  PubMed  Google Scholar 

  3. da Costa L, Thines L, Dehdashti AR, Wallace MC, Willinsky RA, Tymianski M, Schwartz ML, ter Brugge KG (2009) Management and clinical outcome of posterior fossa arteriovenous malformations: report on a single-center 15-year experience. J Neurol Neurosurg Psychiatry 80:376–379

    Article  PubMed  Google Scholar 

  4. Duong DH, Young WL, Vang MC, Sciacca RR, Mast H, Koennecke HC, Hartmann A, Joshi S, Mohr JP, Pile-Spellman J (1998) Feeding artery pressure and venous drainage pattern are primary determinants of hemorrhage from cerebral arteriovenous malformations. Stroke 29:1167–1176

    Article  PubMed  CAS  Google Scholar 

  5. Hernesniemi JA, Dashti R, Juvela S, Vaart K, Niemela M, Laakso A (2008) Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients. Neurosurgery 63:823–829; discussion 829–831

    Article  PubMed  Google Scholar 

  6. Khaw AV, Mohr JP, Sciacca RR, Schumacher HC, Hartmann A, Pile-Spellman J, Mast H, Stapf C (2004) Association of infratentorial brain arteriovenous malformations with hemorrhage at initial presentation. Stroke 35:660–663

    Article  PubMed  CAS  Google Scholar 

  7. Lasjaunias P, Piske R, Terbrugge K, Willinsky R (1988) Cerebral arteriovenous malformations (C. AVM) and associated arterial aneurysms (AA). Analysis of 101 C. AVM cases, with 37 AA in 23 patients. Acta Neurochir (Wien) 91:29–36

    Article  CAS  Google Scholar 

  8. Meisel HJ, Mansmann U, Alvarez H, Rodesch G, Brock M, Lasjaunias P (2000) Cerebral arteriovenous malformations and associated aneurysms: analysis of 305 cases from a series of 662 patients. Neurosurgery 46:793–800; discussion 800–792

    PubMed  CAS  Google Scholar 

  9. Nornes H, Grip A, Wikeby P (1979) Intraoperative evaluation of cerebral hemodynamics using directional Doppler technique. Part 1: arteriovenous malformations. J Neurosurg 50:145–151

    Article  PubMed  CAS  Google Scholar 

  10. Pau A, Cossu M, Turtas S (1994) Association of aneurysm and arteriovenous malformation on the posterior inferior cerebellar artery. Report of three further cases and review of the literature. Acta Neurol (Napoli) 16:52–57

    CAS  Google Scholar 

  11. Perata HJ, Tomsick TA, Tew JM Jr (1994) Feeding artery pedicle aneurysms: association with parenchymal hemorrhage and arteriovenous malformation in the brain. J Neurosurg 80:631–634

    Article  PubMed  CAS  Google Scholar 

  12. Redekop G, TerBrugge K, Montanera W, Willinsky R (1998) Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage. J Neurosurg 89:539–546

    Article  PubMed  CAS  Google Scholar 

  13. Sinclair J, Kelly ME, Steinberg GK (2006) Surgical management of posterior fossa arteriovenous malformations. Neurosurgery 58:ONS-189–ONS-201; discussion ONS-201

    Google Scholar 

  14. Speizler RF, Martin NA (2008) A proposed grading system for arteriovenous malformations. 1986. J Neurosurg 108:186–193

    Article  PubMed  Google Scholar 

  15. Stapf C, Khaw AV, Sciacca RR, Hofmeister C, Schumacher HC, Pile-Spellman J, Mast H, Mohr JP, Hartmann A (2003) Effect of age on clinical and morphological characteristics in patients with brain arteriovenous malformation. Stroke 34:2664–2669

    Article  PubMed  CAS  Google Scholar 

  16. Stapf C, Mast H, Sciacca RR, Choi JH, Khaw AV, Connolly ES, Pile-Spellman J, Mohr JP (2006) Predictors of hemorrhage in patients with untreated brain arteriovenous malformation. Neurology 66:1350–1355

    Article  PubMed  CAS  Google Scholar 

  17. Stapf C, Mohr JP, Pile-Spellman J, Sciacca RR, Hartmann A, Schumacher HC, Mast H (2002) Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation. J Neurol Neurosurg Psychiatry 73:294–298

    Article  PubMed  CAS  Google Scholar 

  18. Stefani MA, Porter PJ, terBrugge KG, Montanera W, Willinsky RA, Wallace MC (2002) Large and deep brain arteriovenous malformations are associated with risk of future hemorrhage. Stroke 33:1220–1224

    Article  PubMed  Google Scholar 

  19. Thompson RC, Steinberg GK, Levy RP, Marks MP (1998) The management of patients with arteriovenous malformations and associated intracranial aneurysms. Neurosurgery 43:202–211; discussion 211–202

    Article  PubMed  CAS  Google Scholar 

  20. Turjman F, Massoud TF, Vinuela F, Sayre JW, Guglielmi G, Duckwiler G (1995) Correlation of the angioarchitectural features of cerebral arteriovenous malformations with clinical presentation of hemorrhage. Neurosurgery 37:856–860; discussion 860–852

    Article  PubMed  CAS  Google Scholar 

  21. Westphal M, Cristante L, Grzyska U, Freckmann N, Zanella F, Zeumer H, Herrmann HD (1994) Treatment of cerebral arteriovenous malformations by neuroradiological intervention and surgical resection. Acta Neurochir (Wien) 130:20–27

    Article  CAS  Google Scholar 

  22. Westphal M, Grzyska U (2000) Clinical significance of pedicle aneurysms on feeding vessels, especially those located in infratentorial arteriovenous malformations. J Neurosurg 92:995–1001

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Nils Ole Schmidt, Matthias Reitz, Frank Raimund, Manfred Westphal & Jan Regelsberger

  2. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Andras Treszl

  3. Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Ulrich Grzyska

Authors
  1. Nils Ole Schmidt
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  2. Matthias Reitz
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  3. Frank Raimund
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  4. Andras Treszl
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  5. Ulrich Grzyska
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  6. Manfred Westphal
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  7. Jan Regelsberger
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Correspondence to Nils Ole Schmidt .

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Editors and Affiliations

  1. Dept. Neurosurgery, Kyoto National Hospital, Mukaihata-cho 1-1, Kyoto, 612-8555, Japan

    Tetsuya Tsukahara

  2. University Medical Center, Department of Neurosurgery, Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, Utrecht, 3508 GA, Netherlands

    Luca Regli

  3. Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Moorenstraße 5, Düsseldorf, 40225, Germany

    Daniel Hänggi

  4. Universitätsklinikum Düsseldorf, Institut für Radiologie, Moorenstraße 5, Düsseldorf, 40335, Germany

    Bernd Turowski

  5. Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Moorenstr. 5, Düsseldorf, 40225, Germany

    Hans-Jakob Steiger

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Schmidt, N.O. et al. (2011). Clinical Relevance of Associated Aneurysms with Arteriovenous Malformations of the Posterior Fossa. In: Tsukahara, T., Regli, L., Hänggi, D., Turowski, B., Steiger, HJ. (eds) Trends in Neurovascular Surgery. Acta Neurochirurgica Supplementum, vol 112. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0661-7_23

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  • DOI: https://doi.org/10.1007/978-3-7091-0661-7_23

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-0660-0

  • Online ISBN: 978-3-7091-0661-7

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