Arteriovenous malformation–associated aneurysms in the pediatric population

Clinical article

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Object

Conventional cerebral angiography and treatment for ruptured arteriovenous malformations (AVMs) in children are often performed in a delayed fashion. In adults, current literature suggests that AVM-associated aneurysms may be more likely to hemorrhage than isolated AVMs, which often leads to earlier angiography and endovascular treatment of associated aneurysms. The nature of AVM-associated aneurysms in the pediatric population is virtually unknown. In this report, the authors investigate the relationship of associated aneurysms in a large group of children with AVMs.

Methods

Seventy-seven pediatric patients (≤ 21 years old) with AVMs were treated at the Columbia University Medical Center between 1991 and 2010. Medical records and imaging studies were retrospectively reviewed, and associated aneurysms were classified as arterial, intranidal, or venous in location. Clinical presentation and outcome variables were compared between children with and without AVM-associated aneurysms.

Results

A total of 30 AVM-associated aneurysms were found in 22 children (29% incidence). Eleven were arterial, 9 intranidal, and 10 were venous in location. There was no significant difference in the rate of hemorrhage (p = 0.91) between children with isolated AVMs (35 of 55 [64%]) and children with AVM-associated aneurysms (13 of 22 [59%]). However, of the 11 children with AVM-associated aneurysms in an arterial location, 10 presented with hemorrhage (91%). An association with hemorrhage was significant in univariate analysis (p = 0.045) but not in multivariate analysis (p = 0.37).

Conclusions

Associated aneurysms are present in nearly a third of children with AVMs, and when arterially located, are more likely to present with hemorrhage. These data suggest that early angiography with endovascular treatment of arterial-based aneurysms in children with AVMs may be indicated.

Abbreviations used in this paper: AVM = arteriovenous malformation; GCS = Glasgow Coma Scale; mRS = modified Rankin scale.

Article Information

Address correspondence to: Richard C. E. Anderson, M.D., The Neurological Institute, 710 West 168th Street, Room 213, New York, New York 10032. email: rca24@columbia.edu.

Please include this information when citing this paper: DOI: 10.3171/2011.10.PEDS11181.

© AANS, except where prohibited by US copyright law.

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Figures

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    Representative angiograms from patients with AVM-associated aneurysms. A: Anteroposterior projection demonstrating a parietal AVM arising from the middle cerebral artery vasculature and a concurrent intranidal aneurysm (arrow). B: Oblique view demonstrating a parietal AVM arising from the middle cerebral artery vasculature with a venous aneurysm (arrow). C: Lateral view demonstrating an occipital AVM arising from the posterior cerebral artery vasculature with an arterial aneurysm (arrow).

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