gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Associated aneurysms in supratentorial arterio-venous malformations: clinical and angiographic characteristics and treatment considerations

Meeting Abstract

  • Klaus-Peter Stein - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
  • Isabel Wanke - Institut für Neuroradiologie, Universitätsklinikum Essen, Essen
  • Mark Schlamann - Institut für Neuroradiologie, Universitätsklinikum Essen, Essen
  • Nicolai El Hindy - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
  • Alexia Moldovan - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
  • Ulrich Sure - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
  • I. Erol Sandalcioglu - Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.12.04

doi: 10.3205/13dgnc278, urn:nbn:de:0183-13dgnc2783

Published: May 21, 2013

© 2013 Stein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: To determine the incidence, angiographic characteristics, and rupture rates of associated aneurysms in supratentorial arterio-venous malformations (AVM).

Method: Of 387 patients with supratentorial AVMs treated between 1990 and 2012, 55 patients (14.2%) harbored aneurysms of the feeding arteries. Venous and intranidal aneurysms were excluded. Feeding artery aneurysms were classified as proximal and distal, according to the classification by Redekop. Patients were retrospectively analyzed in terms of clinical presentation and treatment strategy.

Results: 55 patients exhibited a total of 77 aneurysms of the feeding arteries. Aneurysms were located proximally in 10, distally in 39 and both, proximally and distally in 6 patients. Most frequent locations were the internal carotid artery and the middle cerebral artery. Mean aneurysm size was 4.5 mm ± 3.59mm (range 2–20 mm). Overall 20 patients (36.4%) presented with haemorrhage and 10 patients (18.2%) suffered from rupture of an associated aneurysm. Aneurysm size in patients with haemorrhage was larger (6.75 mm ± 2.71 mm) compared to those unbled (4.2 mm ± 3.60). 18 Patients (33%) underwent endovascular or microsurgical treatment of the aneurysm either alone or in combination with AVM treatment (mean aneurysm size 8 mm ± 4.84 mm, range 3–20 mm). All patients with ruptured aneurysms received treatment accept for one individual, in whom repeated treatment attempts failed. Other reasons for leavening the aneurysm untreated were aneurysm size < 3 mm (n=20), poor clinical condition after initial bleeding (n=4) and treatment refusal by the patients (n=5). In seven patients only the AVM was treated and feeding artery aneurysms were followed-up over a mean time of 31 months.

Conclusions: Among patients with supratentorial AVMs and associated aneurysms of the feeding arteries, aneurysm rupture accounted for 50% of all haemorrhages. Although size of ruptured aneurysms was larger compared to those unbled, rupture occurred the same in smaller aneurysms (≤ 3 mm). Thus, treatment of associated feeding artery aneurysms needs critical consideration, particularly in cases with smaller aneurysms and without haemorrhage.