Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage.

OBJECT The goal of this study was to develop a classification system for aneurysms associated with arteriovenous malformations (AVMs) based on their anatomical and pathophysiological relationships and to determine the incidence and bleeding rates for these aneurysms as well as the effects of AVM treatment on their natural history. METHODS Of 632 patients with AVMs, intranidal aneurysms were found in 35 (5.5%) and flow-related aneurysms in 71 (11.2%). Patients with intranidal aneurysms presented more frequently with hemorrhage (72% compared with 40%, p < 0.001) and had a 9.8% per year risk rate of bleeding during follow-up review. Twelve (17%) of the patients with flow-related aneurysms associated with an AVM presented with hemorrhage from an aneurysm, whereas 15 (21%) bled from their AVM. Seventeen patients underwent angiography after AVM treatment (mean 2.25 years). Of 23 proximal aneurysms, 18 (78.3%) were unchanged, four (17.4%) were smaller, and one (4.3%) had disappeared, whereas four (80%) of five distal aneurysms regressed completely and one was unchanged. Sixteen patients underwent angiography after partial AVM treatment (mean 3.8 years). In cases with less than a 50% reduction in the AVM, no aneurysms regressed, although two enlarged and bled. In cases with greater than a 50% reduction in the AVM, two of three distal aneurysms disappeared and five proximal aneurysms were unchanged. CONCLUSIONS Arterial aneurysms associated with cerebral AVMs may be classified as intranidal, flow-related, or unrelated to the AVM nidus. Intranidal aneurysms have a high correlation with hemorrhagic clinical presentation and a risk of bleeding during the follow-up period that considerably exceeds that which would be expected in their absence. Patients with flow-related aneurysms in association with an AVM may present with hemorrhage from either lesion. Aneurysms that arise on distal feeding arteries near the nidus have a high probability of regressing with substantial or curative AVM therapy.

[1]  A. Algra,et al.  Prevalence and risk of rupture of intracranial aneurysms: a systematic review. , 1998, Stroke.

[2]  P. Stieg,et al.  Cerebral arteriovenous malformation feeding artery aneurysms: a theoretical model of intravascular pressure changes after treatment. , 1997, Neurosurgery.

[3]  P. Lasjaunias.  A Revised Concept of the Congenital Nature of Cerebral Arteriovenous Malformations , 1997, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[4]  R. Macdonald,et al.  Embryological basis of some aspects of cerebral vascular fistulas and malformations. , 1996, Journal of neurosurgery.

[5]  G. Duckwiler,et al.  Correlation of the angioarchitectural features of cerebral arteriovenous malformations with clinical presentation of hemorrhage. , 1995, Neurosurgery.

[6]  J W Sayre,et al.  Aneurysms related to cerebral arteriovenous malformations: superselective angiographic assessment in 58 patients. , 1994, AJNR. American journal of neuroradiology.

[7]  M. Pritz.  Ruptured supratentorial arteriovenous malformations associated with venous aneurysms , 1994 .

[8]  G. Gibbons,et al.  The emerging concept of vascular remodeling. , 1994, The New England journal of medicine.

[9]  W. Young,et al.  The influence of hemodynamic and anatomic factors on hemorrhage from cerebral arteriovenous malformations. , 1994, Neurosurgery.

[10]  J. Tew,et al.  Feeding artery pedicle aneurysms: association with parenchymal hemorrhage and arteriovenous malformation in the brain. , 1994, Journal of neurosurgery.

[11]  H. Alvarez,et al.  Pseudoaneurysms within ruptured intracranial arteriovenous malformations: diagnosis and early endovascular management. , 1993, AJNR. American journal of neuroradiology.

[12]  R. A. Solomon,et al.  The treatment of associated intracranial aneurysms and arteriovenous malformations. , 1992, Journal of neurosurgery.

[13]  M. Marks,et al.  Intranidal aneurysms in cerebral arteriovenous malformations: evaluation and endovascular treatment. , 1992, Radiology.

[14]  P. Wheeler,et al.  The computer-based cumulative report: improvement in quality and efficiency. , 1992, Radiology.

[15]  G. Forbes,et al.  Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions. , 1990, Journal of neurosurgery.

[16]  M. Marks,et al.  Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants. , 1990, Radiology.

[17]  D. Kondziolka,et al.  Cerebral Arteriovenous Malformations with Associated Arterial Aneurysms: Hemodynamic and Therapeutic Considerations , 1988, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[18]  G. Forbes,et al.  The natural history of unruptured intracranial arteriovenous malformations. , 1988, Journal of neurosurgery.

[19]  P Lasjaunias,et al.  Brain arteriovenous malformations: analysis of the angio-architecture in relationship to hemorrhage (based on 152 patients explored and/or treated at the hopital de Bicêtre between 1981 and 1986). , 1988, Journal of neuroradiology. Journal de neuroradiologie.

[20]  H. Duvernoy,et al.  AVM of the brain, history, embryology, pathological considerations, hemodynamics, diagnostic studies, microsurgical anatomy , 1987 .

[21]  J. Taveras,et al.  High-flow angiopathy: cerebral blood vessel changes in experimental chronic arteriovenous fistula. , 1986, AJNR. American journal of neuroradiology.

[22]  H. Batjer,et al.  Intracranial arteriovenous malformations associated with aneurysms. , 1986, Neurosurgery.

[23]  H. Handa,et al.  Location of intracranial aneurysms associated with cerebral arteriovenous malformation: statistical analysis. , 1984, Surgical neurology.

[24]  J. Torner,et al.  Bleeding from cerebral arteriovenous malformations as part of their natural history. , 1983, Journal of neurosurgery.

[25]  S. Wolpert,et al.  The association of cerebral aneurysms, infundibula, and intracranial arteriovenous malformations. , 1982, Stroke.

[26]  J. Suzuki,et al.  Intracranial aneurysms associated with arteriovenous malformations. , 1979, Journal of neurosurgery.

[27]  G. Perret,et al.  Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section VI. Arteriovenous malformations. An analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported to the cooperative study. , 1966, Journal of neurosurgery.

[28]  R. Anderson,et al.  The association of arteriovenous angioma and saccular aneurysm of the arteries of the brain. , 1959, The Journal of pathology and bacteriology.