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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Arteriovenous malformations and associated aneurysms: A comparison of supra- and infratentorial AVMs

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  • N.O. Schmidt - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • M. Reitz - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • A. Treszl - Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg, Eppendorf
  • U. Grzyska - Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf
  • M. Westphal - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • J. Regelsberger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.09

doi: 10.3205/11dgnc074, urn:nbn:de:0183-11dgnc0742

Published: April 28, 2011

© 2011 Schmidt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Recent studies have suggested that AVM-associated aneurysms represent a considerable risk factor for hemorrhage. AVM-associated aneurysms appear to occur more frequently in conjuction with AVMs of the posterior fossa, but data about their risk of rupture is sparse. Here, we report on our single-center experience in the management of posterior fossa AVMs. In particular, we compared the incidence and rupture rate of aneurysms associated with supra- and infratentorial AVMs.

Methods: We performed a retrospective analysis on 474 patients with intracranial AVMs treated at our center from 1990 to 2010. Patients were analyzed for AVM size, drainage type and their clinical course with a focus on vessel anomalies including AVM-associated aneurysms. Variables examined in univariate and multivariate analyses included the presence of AVM-associated aneurysms, hemorrhage related to associated aneurysms, feeding artery aneurysms, AVM location and the presence of high-flow/fistulous components.

Results: 17 (30%) of 57 posterior fossa AVMs versus 46 (11%) of 417 supratentorial AVMs were associated with aneurysms. In 6 (10.5%) versus 7 (1.7%) patients, respectively, flow-associated aneurysms were the source of hemorrhage. Infratentorial AVM location 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 independent 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 was 4% (n=2).

Conclusions: Posterior fossa AVMs display a significantly higher frequency of associated aneurysms of the adjacent vessels, which correlates with the high bleeding rate as compared to AVMs of the supratentorial compartment. We therefore recommend an aggressive AVM treatment including the exclusion of associated aneurysms as a minimal therapeutic goal whenever possible.