The Effect of Flow-Related Aneurysms on Hemorrhagic Risk of Intracranial Arteriovenous Malformations. Issue 4 (9th August 2018)

• Record Type: Journal Article
• Authors: Hung, Alice L; Yang, Wuyang; Jiang, Bowen; Garzon-Muvdi, Tomas; Caplan, Justin M; Colby, Geoffrey P; Coon, Alexander L; Tamargo, Rafael J; Huang, Judy
• Is Part Of: Neurosurgery. Volume 85:Issue 4(2019)
• Page Start: 466
• Page End: 475
• Publication Date: 2018-08-09
• Subjects: Arteriovenous malformation -- Feeding artery -- Aneurysm -- Hemorrhage risk; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy360
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Previous reports indicated an association between hemorrhagic presentation and flow-related aneurysms in arteriovenous malformation (AVM) patients. However, it remains unclear whether these flow-related aneurysms result in the hemorrhage of AVM. OBJECTIVE: To characterize this hemorrhage risk using our institutional experience over 25 yr. METHODS: We retrospectively reviewed records of patients at our institution diagnosed with AVM from 1990 to 2015. Patients without associated aneurysms (AVM only) and those with flow-related aneurysms (AVM-FA) were compared. Those with intranidal or unrelated aneurysms were excluded. Annual risk of AVM-related hemorrhage was calculated using the birth-to-treatment approach and compared using Poisson rate ratio test. RESULTS: Among 526 patients, there were 457 AVM only patients and 69 with flow-related aneurysms. AVM-FA patients were older ( P = .005). AVMs with flow-related aneurysms were more likely located in the cerebellar vermis and hemispheres ( P = .023 and .001, respectively). Presence of flow-related aneurysms increased the risk of presentation with subarachnoid hemorrhage ( P < .001). Interestingly, no significant differences in presenting hemorrhage due to AVM rupture were found ( P > .356). The majority of aneurysms were untreated (69.5%), and only 8 (9.8%) had ruptured presentation. At follow-up (mean = 5.3 yr), patients with flow-related aneurysms were less likely to develop seizures ( P = .004). The annual risk of AVM hemorrhage was 1.33% and 1.05% for AVM only patients and AVM-FA patients, respectively ( P = .248). CONCLUSION: Despite increased risk of subarachnoid hemorrhage at presentation, there was no increased likelihood of rupture in AVMs with flow-related aneurysms. More studies are warranted, as clarifying the competing risks of AVM vs aneurysm rupture may be critical in determining optimal treatment strategy.