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Epidemiology and natural history of arteriovenous malformations

Christian Stapf, Jay P. Mohr, John Pile-Spellman, Robert A. Solomon, Ralph L. Sacco, and E. Sander Connolly Jr.

The epidemiology and natural history of cerebral arteriovenous malformations (AVMs) remains incompletely elucidated. Several factors are responsible. With regard to the incidence and prevalence of AVMs, the results of prior studies have suffered because of the retrospective design, the use of nonspecific ICD-9 codes, and a focus on small genetically isolated populations. Recent data from the New York Islands AVM Hemorrhage Study, an ongoing, prospective, population-based survey determining the incidence of AVM-related hemorrhage and the associated rates of morbidity and mortality in a zip code–defined population of 10 million people, suggests that the AVM detection rate is 1.21/100,000 person-years (95% confidence interval [CI] 1.02–1.42) and the incidence of AVM-hemorrhage is 0.42/100,000 person-years (95% CI 0.32–0.55). Contemporaneous data from the Northern Manhattan Stroke Study, a prospective, longitudinal population-based study of nearly 150,000 patients in which the focus is to define the incidence of stroke, suggest the crude incidence for first-ever AVM-related hemorrhage to be 0.55/100,000 person-years (95% CI 0.11–1.61). Efforts are ongoing to study the natural history of both ruptured and unruptured AVMs in these datasets to examine the relevance of prior studies of patients selected for conservative follow up in Finland. In addition, data are being gathered to determine whether risk factors for future hemorrhage, which have previously been established in small case series, are valid when applied to whole populations. Together, these data should help inform therapeutic decisionmaking.

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Arteriovenous malformations

Summary of 100 consecutive supratentorial cases

Dwight Parkinson and Gary Bachers

T he demonstration by Harvey 21 of the directional flow through arteries and veins, and then Malpighi's 45 description of capillaries, set the stage for the recognition by Hunter 29, 30 and Steindel 81 of the arteriovenous malformation (AVM). It remained for Holman 25 to discourage attempts to obliterate such a lesion in the extremities by occlusion of entering or leaving vessels; he emphasized the importance of obliterating the fistula. Simultaneous publications by both Dandy 12 and Cushing and Bailey 10 recognized that the solution depended on

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Arteriovenous malformation and oligodendroglioma

Case report

Robert M. Crowell, Umberto DeGirolami, and William H. Sweet

R eported cases of arteriovenous malformation (AVM) of the central nervous system in association with a primary brain tumor are very rare; 1, 3, 10 only one case of AVM accompanying oligodendroglioma has been previously recorded. 1 We are now reporting a case of oligodendroglioma within an AVM. Case Report First Admission In June, 1971, this 17-year-old right-handed man suddenly felt pain “like an explosion” in the right eye which persisted for approximately 4 hours. Similar headaches recurred almost daily after the first episode. In early July

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Intrachiasmatic arteriovenous malformation

Case report

Richard A. Roski, John H. Gardner, and Robert F. Spetzler

W e are reporting an unusual occurrence of a cryptic arteriovenous malformation (AVM) situated completely within the optic tract and chiasm. Surgical removal of the AVM resulted in complete resolution of the patient's visual problems. Case Report This 37-year-old man was admitted to the University Hospitals complaining of blurred vision for the past 5 to 6 days. A similar episode had occurred 6 months prior to admission, and cleared over several days. Each episode was associated with mild headache. Examination . Physical examination was entirely within

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Familial arteriovenous malformations

Report of four cases in one family

Michael C. Boyd, Paul Steinbok, and Donald W. Paty

F amilial arteriovenous malformation (AVM) of the central nervous system has been reported only seven times in the English literature; 1–3, 6–8, 12 two of these cases have been associated with hereditary telangiectasia. 3, 7 In addition, two cases reported in German have been referred to by Aberfeld and Rao. 1 We report a family in which four members of two generations are proven to have AVM's. Case Reports Case 1 This 18-year-old man with a 2-year history of episodic blurring of vision and dizziness experienced two generalized seizures on the day

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Posterior fossa arteriovenous malformations

Omar M. Arnaout, Bradley A. Gross, Christopher S. Eddleman, Bernard R. Bendok, Christopher C. Getch, and H. Hunt Batjer

authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. References 1 Al-Shahi R , Warlow C : A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults . Brain 124 : 1900 – 1926 , 2001 10.1093/brain/124.10.1900 2 Batjer H , Samson D : Arteriovenous malformations of the posterior fossa: clinical presentation, diagnostic evaluation and surgical treatment . Neurosurg Rev 9 : 287 – 296 , 1986 10.1007/BF01743635 3 Brown

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Multiple dural arteriovenous malformations

Report of two cases

Naoya Kuwayama, Akira Takaku, Michiharu Nishijima, Shunro Endo, and Masato Hirao

D ural arteriovenous malformations (AVM's) occur most frequently related to the cavernous sinus (so-called “spontaneous carotid cavernous fistulas”) and lateral sinuses (transverse and sigmoid sinuses). Two cases with multiple dural AVM's involving the cavernous and the lateral sinuses are reported. Although a few cases with multiple dural AVM's emptying into the superior sagittal sinus (SSS) and the lateral sinus have been reported, involvement of both the cavernous sinus and the lateral sinus is extremely rare. It is of interest that in one of these patients

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Extensive dural arteriovenous malformation

Case report

Ossama Al-Mefty, John R. Jinkins, and John L. Fox

D ural arteriovenous malformations (AVM's) in the region of the transverse sigmoid sinus, although rare, represent a well-defined entity from both clinical and angiographic aspects. 1, 7–9, 13, 14 The etiology and pathology of these anomalies remain controversial. 1, 7, 12–14, 24, 25 The clinical findings are determined by the volume, direction, and route of the venous drainage. The disease often progresses, leading to increasing neurological deficits, elevation of intracranial pressure, hydrocephalus, seizures, and hemorrhage. 2, 7, 8, 13, 24 Unilateral

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Intracranial arteriovenous malformations

Conservative and surgical treatment

Beniamino Guidetti and Alberto Delitala

A lthough much has been written on the treatment of intracranial arteriovenous malformations (AVM's), there is still doubt as to the real advantages of surgical as opposed to conservative treatment. 3–5, 7, 10, 17, 20–22 Our report concerns the late results of a series of 145 patients with intracranial AVM's treated either conservatively or surgically. Clinical Material Of our 145 patients, 95 received surgical and 50 conservative treatment. The great majority of these patients were followed up from 2 to 25 years; 15 were lost to follow-up review, but

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Medial occipital arteriovenous malformations

Surgical treatment

Neil A. Martin and Charles B. Wilson

A s a general rule, arteriovenous malformations (AVM's) do not encompass viable brain; the vessels are separated by gliotic neural parenchyma. 4 This anatomic feature of AVM's permits their removal without damage to the functional brain that surrounds the malformation. We describe the technique and results of surgical excision of AVM's from the medial occipital lobe — that region which includes the visual cortex. Medial occipital AVM's have distinct clinical and anatomic features. Vascular malformations in this location have a tendency to cause migrainous