Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2002 Sep;73(3):294–298. doi: 10.1136/jnnp.73.3.294

Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation

C Stapf 1, J Mohr 1, J Pile-Spellman 1, R Sciacca 1, A Hartmann 1, H Schumacher 1, H Mast 1
PMCID: PMC1738025  PMID: 12185161

Abstract

Objective: To assess the effect of concurrent arterial aneurysms on the risk of incident haemorrhage from brain arteriovenous malformations (AVMs).

Methods: In a cross sectional study, 463 consecutive, prospectively enrolled patients from the Columbia AVM Databank were analysed. Concurrent arterial aneurysms on brain angiography were classified as feeding artery aneurysms, intranidal aneurysms, and aneurysms unrelated to blood flow to the AVM. Clinical presentation (diagnostic event) was categorised as intracranial haemorrhage proved by imaging or non-haemorrhagic presentation. Univariate and multivariate statistical models were applied to test the effect of age, sex, AVM size, venous drainage pattern, and the three types of aneurysms on the risk of AVM haemorrhage at initial presentation.

Results: Arterial aneurysms were found in 117 (25%) patients with AVM (54 had feeding artery aneurysms, 21 had intranidal aneurysms, 18 had unrelated aneurysms, and 24 had more than one aneurysm type). Intracranial haemorrhage was the presenting symptom in 204 (44%) patients with AVM. In the univariate model, the relative risk for haemorrhagic AVM presentation was 2.28 (95% confidence interval (CI) 1.12 to 4.64) for patients with intranidal aneurysms and 1.88 (95% CI 1.14 to 3.08) for those with feeding artery aneurysms. In the multivariate model an independent effect of feeding artery aneurysms (odds ratio 2.11, 95% CI 1.18 to 3.78) on haemorrhagic AVM presentation was found. No significant effect was seen for intranidal and unrelated aneurysms. The attributable risk of feeding artery aneurysms for incident haemorrhage in patients with AVM was 6% (95% CI 1% to 11%).

Conclusions: The findings suggest that feeding artery aneurysms are an independent determinant for increased risk of incident AVM haemorrhage.

Full Text

The Full Text of this article is available as a PDF (182.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANDERSON R. M., BLACKWOOD W. The association of arteriovenous angioma and saccular aneurysm of the arteries of the brain. J Pathol Bacteriol. 1959 Jan;77(1):101–110. [PubMed] [Google Scholar]
  2. Batjer H., Suss R. A., Samson D. Intracranial arteriovenous malformations associated with aneurysms. Neurosurgery. 1986 Jan;18(1):29–35. doi: 10.1227/00006123-198601000-00006. [DOI] [PubMed] [Google Scholar]
  3. Brown R. D., Jr, Wiebers D. O., Forbes G. S. Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions. J Neurosurg. 1990 Dec;73(6):859–863. doi: 10.3171/jns.1990.73.6.0859. [DOI] [PubMed] [Google Scholar]
  4. Brown R. D., Jr, Wiebers D. O., Torner J. C., O'Fallon W. M. Incidence and prevalence of intracranial vascular malformations in Olmsted County, Minnesota, 1965 to 1992. Neurology. 1996 Apr;46(4):949–952. doi: 10.1212/wnl.46.4.949. [DOI] [PubMed] [Google Scholar]
  5. Deruty R., Mottolese C., Soustiel J. F., Pelissou-Guyotat I. Association of cerebral arteriovenous malformation and cerebral aneurysm. Diagnosis and management. Acta Neurochir (Wien) 1990;107(3-4):133–139. doi: 10.1007/BF01405792. [DOI] [PubMed] [Google Scholar]
  6. Duong D. H., Young W. L., Vang M. C., Sciacca R. R., Mast H., Koennecke H. C., Hartmann A., Joshi S., Mohr J. P., Pile-Spellman J. Feeding artery pressure and venous drainage pattern are primary determinants of hemorrhage from cerebral arteriovenous malformations. Stroke. 1998 Jun;29(6):1167–1176. doi: 10.1161/01.str.29.6.1167. [DOI] [PubMed] [Google Scholar]
  7. Fleiss J. L. Inference about population attributable risk from cross-sectional studies. Am J Epidemiol. 1979 Aug;110(2):103–104. doi: 10.1093/oxfordjournals.aje.a112794. [DOI] [PubMed] [Google Scholar]
  8. Hartmann A., Mast H., Mohr J. P., Koennecke H. C., Osipov A., Pile-Spellman J., Duong D. H., Young W. L. Morbidity of intracranial hemorrhage in patients with cerebral arteriovenous malformation. Stroke. 1998 May;29(5):931–934. doi: 10.1161/01.str.29.5.931. [DOI] [PubMed] [Google Scholar]
  9. Hartmann A., Stapf C., Hofmeister C., Mohr J. P., Sciacca R. R., Stein B. M., Faulstich A., Mast H. Determinants of neurological outcome after surgery for brain arteriovenous malformation. Stroke. 2000 Oct;31(10):2361–2364. doi: 10.1161/01.str.31.10.2361. [DOI] [PubMed] [Google Scholar]
  10. Hofmeister C., Stapf C., Hartmann A., Sciacca R. R., Mansmann U., terBrugge K., Lasjaunias P., Mohr J. P., Mast H., Meisel J. Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation. Stroke. 2000 Jun;31(6):1307–1310. doi: 10.1161/01.str.31.6.1307. [DOI] [PubMed] [Google Scholar]
  11. Kondziolka D., Nixon B. J., Lasjaunias P., Tucker W. S., TerBrugge K., Spiegel S. M. Cerebral arteriovenous malformations with associated arterial aneurysms: hemodynamic and therapeutic considerations. Can J Neurol Sci. 1988 May;15(2):130–134. doi: 10.1017/s0317167100027487. [DOI] [PubMed] [Google Scholar]
  12. Langer D. J., Lasner T. M., Hurst R. W., Flamm E. S., Zager E. L., King J. T., Jr Hypertension, small size, and deep venous drainage are associated with risk of hemorrhagic presentation of cerebral arteriovenous malformations. Neurosurgery. 1998 Mar;42(3):481–489. doi: 10.1097/00006123-199803000-00008. [DOI] [PubMed] [Google Scholar]
  13. Lasjaunias P., Piske R., Terbrugge K., Willinsky R. Cerebral arteriovenous malformations (C. AVM) and associated arterial aneurysms (AA). Analysis of 101 C. AVM cases, with 37 AA in 23 patients. Acta Neurochir (Wien) 1988;91(1-2):29–36. doi: 10.1007/BF01400524. [DOI] [PubMed] [Google Scholar]
  14. MCKISSOCK W., PATERSON J. H. A clinical survey of intracranial angiomas with special reference to their mode of progression and surgical treatment: a report of 110 cases. Brain. 1956 Jun;79(2):233–266. doi: 10.1093/brain/79.2.233. [DOI] [PubMed] [Google Scholar]
  15. Mansmann U., Meisel J., Brock M., Rodesch G., Alvarez H., Lasjaunias P. Factors associated with intracranial hemorrhage in cases of cerebral arteriovenous malformation. Neurosurgery. 2000 Feb;46(2):272–281. doi: 10.1097/00006123-200002000-00004. [DOI] [PubMed] [Google Scholar]
  16. Marks M. P., Lane B., Steinberg G. K., Chang P. J. Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants. Radiology. 1990 Sep;176(3):807–813. doi: 10.1148/radiology.176.3.2389040. [DOI] [PubMed] [Google Scholar]
  17. Mast H., Young W. L., Koennecke H. C., Sciacca R. R., Osipov A., Pile-Spellman J., Hacein-Bey L., Duong H., Stein B. M., Mohr J. P. Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet. 1997 Oct 11;350(9084):1065–1068. doi: 10.1016/s0140-6736(97)05390-7. [DOI] [PubMed] [Google Scholar]
  18. Meisel H. J., Mansmann U., Alvarez H., Rodesch G., Brock M., Lasjaunias P. Cerebral arteriovenous malformations and associated aneurysms: analysis of 305 cases from a series of 662 patients. Neurosurgery. 2000 Apr;46(4):793–802. doi: 10.1097/00006123-200004000-00004. [DOI] [PubMed] [Google Scholar]
  19. Nataf F., Meder J. F., Roux F. X., Blustajn J., Merienne L., Merland J. J., Schlienger M., Chodkiewicz J. P. Angioarchitecture associated with haemorrhage in cerebral arteriovenous malformations: a prognostic statistical model. Neuroradiology. 1997 Jan;39(1):52–58. doi: 10.1007/s002340050367. [DOI] [PubMed] [Google Scholar]
  20. Piotin M., Ross I. B., Weill A., Kothimbakam R., Moret J. Intracranial arterial aneurysms associated with arteriovenous malformations: endovascular treatment. Radiology. 2001 Aug;220(2):506–513. doi: 10.1148/radiology.220.2.r01au09506. [DOI] [PubMed] [Google Scholar]
  21. Redekop G., TerBrugge K., Montanera W., Willinsky R. Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage. J Neurosurg. 1998 Oct;89(4):539–546. doi: 10.3171/jns.1998.89.4.0539. [DOI] [PubMed] [Google Scholar]
  22. Stapf Christian, Labovitz Daniel L., Sciacca Robert R., Mast Henning, Mohr Jay P., Sacco Ralph L. Incidence of adult brain arteriovenous malformation hemorrhage in a prospective population-based stroke survey. Cerebrovasc Dis. 2002;13(1):43–46. doi: 10.1159/000047745. [DOI] [PubMed] [Google Scholar]
  23. Stefani Marco A., Porter Phillip J., terBrugge Karel G., Montanera Walter, Willinsky Robert A., Wallace M. Christopher. Angioarchitectural factors present in brain arteriovenous malformations associated with hemorrhagic presentation. Stroke. 2002 Apr;33(4):920–924. doi: 10.1161/01.str.0000014582.03429.f7. [DOI] [PubMed] [Google Scholar]
  24. Suzuki J., Onuma T. Intracranial aneurysms associated with arteriovenous malformations. J Neurosurg. 1979 Jun;50(6):742–746. doi: 10.3171/jns.1979.50.6.0742. [DOI] [PubMed] [Google Scholar]
  25. Thompson R. C., Steinberg G. K., Levy R. P., Marks M. P. The management of patients with arteriovenous malformations and associated intracranial aneurysms. Neurosurgery. 1998 Aug;43(2):202–212. doi: 10.1097/00006123-199808000-00006. [DOI] [PubMed] [Google Scholar]
  26. Turjman F., Massoud T. F., Viñuela F., Sayre J. W., Guglielmi G., Duckwiler G. Aneurysms related to cerebral arteriovenous malformations: superselective angiographic assessment in 58 patients. AJNR Am J Neuroradiol. 1994 Oct;15(9):1601–1605. [PMC free article] [PubMed] [Google Scholar]
  27. Turjman F., Massoud T. F., Viñuela F., Sayre J. W., Guglielmi G., Duckwiler G. Correlation of the angioarchitectural features of cerebral arteriovenous malformations with clinical presentation of hemorrhage. Neurosurgery. 1995 Nov;37(5):856–862. doi: 10.1227/00006123-199511000-00002. [DOI] [PubMed] [Google Scholar]
  28. Voigt K., Beck U., Reinshagen G. A complex cerebral vascular malformation studied by angiography; multiple aneurysms angiomas and arterial ectasia. Neuroradiology. 1973 Apr;5(2):117–123. doi: 10.1007/BF00337496. [DOI] [PubMed] [Google Scholar]
  29. Westphal M., Grzyska U. Clinical significance of pedicle aneurysms on feeding vessels, especially those located in infratentorial arteriovenous malformations. J Neurosurg. 2000 Jun;92(6):995–1001. doi: 10.3171/jns.2000.92.6.0995. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES