Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Radiology, Emory University School of Medicine, Atlanta, Georgia.
Oper Neurosurg (Hagerstown). 2018 Apr 1;14(4):359-366. doi: 10.1093/ons/opx120.
Posterior fossa arteriovenous malformations (AVMs) are associated with increased risk of rupture and severe consequences from such rupture. The hemorrhagic risk of prenidal aneurysms (anr) on the posterior inferior cerebellar artery (PICA) may exceed that of the AVM in posterior fossa AVMs fed by PICA (PICA-AVM).
To characterize the relative risks of aneurysm and AVM hemorrhage in patients with posterior fossa AVMs.
We retrospectively reviewed patients diagnosed with AVM. Patients with posterior fossa AVMs were divided into 3 groups: PICA-AVM with prenidal aneurysm (PICA-AVM-anr group), PICA-AVM without prenidal aneurysm (PICA-AVM group), and AVMs without PICA feeder with/without aneurysm (AVM-only group). Patient and lesion characteristics and treatment outcomes were compared. ANOVA and chi squared tests were used for statistical analyses.
Our cohort included 85 patients. Mean age was 45.3 ± 18.1 yr, with 43(50.6%) female patients. Fifty-one patients (60.0%) had hemorrhagic presentation, and 27 (31.8%) experienced acute hydrocephalus. Patients in the PICA-AVM-anr group (n = 11) were more likely to present with aneurysmal subarachnoid hemorrhage (SAH; P = .005) and less likely to have AVM rupture (P < .001). Ten (90.9%) patients presented with hemorrhage, 6 (60.0%) of which resulted from aneurysm rupture. Of these 6, 5 (83.3%) had acute hydrocephalus. No patients with AVM rupture had hydrocephalus. Eight (72.7%) received aneurysm treatment prior to AVM treatment. There were no significant differences in post-treatment outcomes dependent on treatment order.
In addition to relatively higher risk of AVM rupture from infratentorial location and prenidal aneurysm, a higher risk of aneurysm rupture rather than AVM rupture was observed in patients with PICA-AVM-anr complex.
后颅窝动静脉畸形（AVM）与破裂风险增加和由此破裂引起的严重后果相关。后下小脑脑动脉（PICA）供血的后颅窝 AVM 中，后颅窝 prenidal 动脉瘤（anr）的出血风险可能超过由 PICA 供血的后颅窝 AVM（PICA-AVM）中的 AVM。
描述后颅窝 AVM 患者中动脉瘤和 AVM 出血的相对风险。
我们回顾性地分析了诊断为 AVM 的患者。将后颅窝 AVM 患者分为 3 组：有 prenidal 动脉瘤的 PICA-AVM（PICA-AVM-anr 组）、无 prenidal 动脉瘤的 PICA-AVM（PICA-AVM 组）和无 PICA 供血的 AVM 伴/不伴动脉瘤（AVM-only 组）。比较患者和病变特征以及治疗结果。使用方差分析和卡方检验进行统计学分析。
我们的队列包括 85 名患者。平均年龄为 45.3±18.1 岁，女性 43 例（50.6%）。51 例（60.0%）患者有出血表现，27 例（31.8%）发生急性脑积水。PICA-AVM-anr 组（n=11）更可能出现动脉瘤性蛛网膜下腔出血（SAH；P=0.005），而不太可能发生 AVM 破裂（P<0.001）。10 例（90.9%）患者出现出血，其中 6 例（60.0%）由动脉瘤破裂引起。其中 6 例中有 5 例（83.3%）出现急性脑积水。没有 AVM 破裂患者发生脑积水。8 例（72.7%）患者在治疗 AVM 之前接受了动脉瘤治疗。治疗顺序对治疗后结果没有显著影响。
除了位于后颅窝和 prenidal 动脉瘤导致的相对较高的 AVM 破裂风险外，PICA-AVM-anr 复合患者还观察到动脉瘤破裂的风险高于 AVM 破裂的风险。
