Posterior fossa arteriovenous malformations

2009 ◽  
Vol 26 (5) ◽  
pp. E12 ◽  
Author(s):  
Omar M. Arnaout ◽  
Bradley A. Gross ◽  
Christopher S. Eddleman ◽  
Bernard R. Bendok ◽  
Christopher C. Getch ◽  
...  
Keyword(s):  
Natural History ◽  
Posterior Fossa ◽  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Therapeutic Options ◽  
Aggressive Treatment

Arteriovenous malformations (AVMs) of the posterior fossa are complex neurovascular lesions that are less common than their supratentorial counterparts, accounting for < 15% of all AVMs. The majority of patients with these lesions present with intracranial hemorrhage, a factor that has been consistently shown to increase one's risk for subsequent bleeding. Studies have additionally shown a posterior fossa or deep AVM location to portend a more aggressive natural history. The authors reviewed the literature on posterior fossa AVMs, finding their annual rupture rates to be as high as 11.6%, an important factor that underscores the importance of aggressive treatment of lesions amenable to intervention as therapeutic options and results continue to improve.

Associated Aneurysms in Infratentorial Arteriovenous Malformations: Role of Aneurysm Size and Comparison with Supratentorial Lesions

2016 ◽  
Vol 41 (5-6) ◽  
pp. 219-225 ◽  
Author(s):  
Klaus-Peter Stein ◽  
Isabel Wanke ◽  
Michael Forsting ◽  
Neriman Oezkan ◽  
Bernd-Otto Huetter ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Posterior Inferior Cerebellar Artery ◽  
Aneurysm Rupture ◽  
Special Focus ◽  
Aneurysm Size ◽  
Common Location ◽  
Mean Size ◽  
The Mean

Background: The natural history and treatment of brain arteriovenous malformations (AVMs) is the object of ongoing debates and discussions. To capture the entirety of these complex lesions, associated vascular pathologies, such as associated aneurysms (AAs), have to be implemented in future risk stratification models, as they are believed to represent additional risk factors for intracranial hemorrhage. The present study aims to determine AA characteristics in posterior fossa AVMs and to compare with AAs accompanying supratentorial AVMs, with special focus on aneurysm size. Methods: Patients with cerebral AVMs, treated in our department between 1990 and 2013, were analyzed retrospectively. Only patients with flow-related AAs of the feeding arteries were evaluated. Thus, patients harboring intranidal, venous or remote aneurysms were excluded. Results: Of 485 patients with cerebral AVM, 76 patients harbored an AVM of the posterior fossa. Among those, 22 individuals exhibited a total of 35 AAs (n = 8 patients with multiple AAs). Most common location of AAs was the posterior inferior cerebellar artery (n = 20, 57%) and mean AA diameter was 7.9 mm (SD 5.5). In the subgroup of patients with a single AA, mean aneurysm size in posterior fossa AVMs was with 7.8 mm (SD 6.0; range 2-25 mm) significantly larger than the mean size of AAs with supratentorial AVMs (4.8 mm, SD 3.0; range 2-20 mm; p = 0.048). Intracranial hemorrhage was found in 18 of 22 patients (82%) with infratentorial AVMs, and of these, 11 patients suffered from aneurysm rupture. In 14 patients bearing a single AA, 8 (57%) had sustained hemorrhage from aneurysm rupture. The mean diameter of AAs was as supposed in the ruptured group with 9.8 mm (SD 6.9; range 4-25 mm) significantly larger than in the unruptured AA group exhibiting a mean of 5.0 mm (SD 3.3; range 2-10 mm; p = 0.038). Patients with posterior fossa AVMs and AAs were significantly older as compared to those patients with supratentorial lesions (57.1, SD 12.6 vs. 45.8 years, SD 15.9 years; p = 0.004), which was also evident in the subgroup of patients with single AAs (55.2, SD 11.7 vs. 45.8 years, SD 14.9 years; p = 0.038). Conclusions: AAs of posterior fossa AVMs are larger in diameter than aneurysms accompanying supratentorial AVMs. AA size influences risk for hemorrhage, which, together with the high number of hemorrhagic events in posterior fossa AVMs, justifies treating these pathologies. The higher age of patients with AVMs of the posterior fossa might be one reason for larger AAs in this cohort, when compared to patients with supratentorial AVMs and AAs.

Natural History of Arteriovenous Malformations of the Brain: A Clinical Study

Neurosurgery ◽  
1984 ◽  
Vol 15 (5) ◽  
pp. 658-662 ◽  
Author(s):  
Dan Fults ◽  
David L. Kelly
Keyword(s):  
Clinical Study ◽  
Natural History ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations ◽  
Recurrent Hemorrhage ◽  
History Of ◽  
The Brain

Abstract The natural history of intracranial arteriovenous malformations (AVMs) was studied in 131 patients. The 83 patients managed nonsurgically and the 48 patients treated surgically were followed for an average of 8 years. Hemorrhage occurred in 61.8% of all patients. A second hemorrhage occurred in 67.4% of the survivors of the first hemorrhage. The mortality associated with recurrent hemorrhage did not increase significantly with successive episodes of hemorrhage. The rate of rebleeding was 17.9%/year initially, but declined to 3%/year after 5 years and then to 2%/year after 10 years. Among patients treated nonsurgically, the prognosis was more favorable for patients presenting with seizures than for patients presenting with hemorrhage. Patients in the seizure group had a 26.9% incidence of hemorrhage causing an 11.6% mortality; 40.5% of the patients in the hemorrhage group died. The prognosis was poor for patients with posterior fossa A V Ms; the mortality was 66.7% with the first hemorrhage. Recurrent posterior fossa hemorrhage was the rule in survivors, and most of those hemorrhages were fatal. The prognosis for children with AVMs was no different from that for adults.

Intracranial Arteriovenous Malformations

2019 ◽  
pp. 585-593
Author(s):  
Kelly D. Flemming ◽  
Michael J. Link
Keyword(s):  
Natural History ◽  
Brain Imaging ◽  
Intracranial Hemorrhage ◽  
Vascular Malformation ◽  
Arteriovenous Malformations ◽  
Medical Attention ◽  
Intracranial Arteriovenous Malformations ◽  
Radiographic Findings ◽  
Intracranial Vascular Malformation ◽  
Arteries And Veins

Intracranial arteriovenous malformations (AVMs) are a type of intracranial vascular malformation that consists of an abnormal connection of arteries and veins without intervening capillary beds. AVMs may come to medical attention because of seizure, intracranial hemorrhage, or incidental radiographic findings in a patient undergoing brain imaging for a different indication. This chapter focuses on the epidemiology, natural history, diagnosis, and management of intracranial AVMs.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

Characteristics of Brain Arteriovenous Malformations Presenting with Seizures without Acute or Remote Hemorrhage

2011 ◽  
Vol 24 (6) ◽  
pp. 886-888 ◽  
Author(s):  
P. Jiang ◽  
X. Lv ◽  
Z. Wu ◽  
Y. Li ◽  
C. Jiang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Brain Arteriovenous Malformations ◽  
Male Sex

We report on the predictors of seizure presention in unruptured brain arteriovenous malformations (AVMs). Between 1999 and 2008, 302 consecutive patients with AVMs were referred to our institution for endovascular treatment. Seventy-four patients (24.5%) experienced seizures without hemorrhage before treatment. We tested for statistical associations between angioarchitectural characteristics and seizure presentation. When we compared the 74 patients with seizures without hemorrhage with the 228 patients who did not experience seizures initially (total of 302 patients), male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage were statistically associated with seizures (P=0.016, P=0.002, P=0.022, P=0.005, and P=0.022, respectively). Posterior fossa and deep locations and coexisting aneurysms were statistically associated with no seizures. The angioarchitectural characteristics of AVM associated with seizure presentation include male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage.

Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions

1990 ◽  
Vol 73 (6) ◽  
pp. 859-863 ◽  
Author(s):  
Robert D. Brown ◽  
David O. Wiebers ◽  
Glenn S. Forbes
Keyword(s):  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Low Flow ◽  
Content Type ◽  
Unruptured Intracranial Aneurysms ◽  
The Difference ◽  
Arterial Feeder ◽  
Relationship Of ◽  
The Relationship ◽  
Feeding Systems

✓ Among 91 patients with unruptured intracranial arteriovenous malformations (AVM's), 16 patients had 26 unruptured intracranial saccular aneurysms. An actuarial analysis showed the risk of intracranial hemorrhage among patients with coexisting aneurysm and AVM to be 7% per year at 5 years following diagnosis compared to 1.7% for patients with AVM alone. The difference in length of survival free of hemorrhage was significant (log-rank, p < 0.0007). Several angiographic and clinical parameters were investigated to better understand the relationship of these lesions. The aneurysms occurred in similar percentages in patients with small, medium, and large AVM's. Twenty-five aneurysms were on arteries feeding the malformation system, almost equally distributed proximally and distally. Eleven aneurysms were atypical in location, and all arose from primary or secondary branch feeders to the malformation; 24 were on enlarged feeding arteries. Eleven (16%) of the 67 patients with high-flow AVM's had associated aneurysms, compared with five (21%) of the 24 patients with low-flow AVM's. Four (16%) of 25 low-shunt malformations and 12 (18%) of 65 high-shunt malformations had associated aneurysms. All five aneurysms associated with low-shunt malformations were on a direct arterial feeder of the malformation. These data suggest that the intracranial AVM's predispose to aneurysm formation within AVM feeding systems and that the mechanism is not simply based upon the high blood flow or high arteriovenous shunt in these systems.

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