The natural history of aneurysms and arteriovenous malformations

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  • 1 Department of Neurosurgery and Epidemiology Program, University of Virginia, Charlottesville, Virginia; and Department of Neurosurgery, University of Washington, Seattle, Washington
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✓ The authors summarize the findings of previous studies relating to the natural history of aneurysms and arteriovenous malformations (AVM's). Ruptured aneurysms have their highest rate of rebleeding on Day 1, and at least 50% will rebleed during the 6 months after the first hemorrhage. Thereafter, the rate drops to at least 3% a year. This is the same rate as seen in anterior and posterior communicating artery aneurysms treated by anterior cerebral artery clipping and carotid ligation; these operations provide immediate protection but do not result in long-term diminution of the risk of rebleeding. Patients with unruptured incidental and unruptured multiple aneurysms rebleed at a rate of 1% per year, as do patients with subarachnoid hemorrhage of unknown etiology. The risk of rebleeding for AVM's is 3% a year.

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Contributor Notes

Address for Dr. Winn: Department of Neurosurgery, University of Washington, Seattle, Washington.

Address reprint requests to: John A. Jane, M.D., Department of Neurosurgery, Box 212, University of Virginia Hospital, Charlottesville, Virginia 22908.
  • 1.

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  • 2.

    Henderson WG, , Torner JC, & Nibbelink DW: Intracranial aneurysms and subarachnoid hemorrhage — report on a randomized treatment study. IV-B. Regulated bedrest — statistical evaluation. Stroke 8:579589, 1977 Henderson WG, Torner JC, Nibbelink DW: Intracranial aneurysms and subarachnoid hemorrhage — report on a randomized treatment study. IV-B. Regulated bedrest — statistical evaluation. Stroke 8:579–589, 1977

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  • 3.

    Jane JA, , Winn HR, & Richardson AE: The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implications for surgical management. Clin Neurosurg 24:176184, 1977 Jane JA, Winn HR, Richardson AE: The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implications for surgical management. Clin Neurosurg 24:176–184, 1977

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  • 4.

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  • 5.

    Kassell NF, & Torner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479481, 1983 Kassell NF, Torner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479–481, 1983

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  • 6.

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  • 7.

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  • 8.

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  • 9.

    Richardson AE, , Jane JA, & Payne PM: Assessment of the natural history of anterior communicating aneurysms. J Neurosurg 21:226274, 1964 Richardson AE, Jane JA, Payne PM: Assessment of the natural history of anterior communicating aneurysms. J Neurosurg 21:226–274, 1964

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  • 10.

    Richardson AE, , Jane JA, & Payne PM: The prediction of morbidity and mortality in anterior communicating aneurysms treated by proximal anterior cerebral ligation. J Neurosurg 25:280283, 1966 Richardson AE, Jane JA, Payne PM: The prediction of morbidity and mortality in anterior communicating aneurysms treated by proximal anterior cerebral ligation. J Neurosurg 25:280–283, 1966

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  • 11.

    Richardson AE, , Jane JA, & Yashon D: Prognostic factors in the untreated course of posterior communicating aneurysms. Arch Neurol 14:172176, 1966 Richardson AE, Jane JA, Yashon D: Prognostic factors in the untreated course of posterior communicating aneurysms. Arch Neurol 14:172–176, 1966

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  • 12.

    Sahs AL, , Nibbelink DW, & Torner JC (eds): Aneurysmal Subarachnoid Hemorrhage. Report of the Cooperative Study. Baltimore: Urban & Schwarzenberg, 1981 Sahs AL, Nibbelink DW, Torner JC (eds): Aneurysmal Subarachnoid Hemorrhage. Report of the Cooperative Study. Baltimore: Urban & Schwarzenberg, 1981

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  • 13.

    Torner JC, , Nibbelink DW, & Burmeister LF: Statistical comparisons of end results of a randomized study, in Sahs AL, , Nibbelink DW, & Torner JC (eds): Aneurysmal Subarachnoid Hemorrhage. Report of the Cooperative Study. Baltimore: Urban & Schwarzenberg, 1981, pp 249276 Torner JC, Nibbelink DW, Burmeister LF: Statistical comparisons of end results of a randomized study, in Sahs AL, Nibbelink DW, Torner JC (eds): Aneurysmal Subarachnoid Hemorrhage. Report of the Cooperative Study. Baltimore: Urban & Schwarzenberg, 1981, pp 249–276

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  • 14.

    Winn HR, , Almaani WS, & Berga SL, et al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59:642651, 1983 Winn HR, Almaani WS, Berga SL, et al: The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms. J Neurosurg 59:642–651, 1983

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  • 15.

    Winn HR, , Richardson AE, & Jane JA: Late morbidity and mortality of common carotid ligation for posterior communicating aneurysms. A comparison to conservative treatment. J Neurosurg 47:727736, 1977 Winn HR, Richardson AE, Jane JA: Late morbidity and mortality of common carotid ligation for posterior communicating aneurysms. A comparison to conservative treatment. J Neurosurg 47:727–736, 1977

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  • 16.

    Winn HR, , Richardson AE, & Jane JA: The long-term prognosis in untreated cerebral aneurysms: I. The incidence of late hemorrhage in cerebral aneurysm: a 10-year evaluation of 364 patients. Ann Neurol 1:358370, 1977 Winn HR, Richardson AE, Jane JA: The long-term prognosis in untreated cerebral aneurysms: I. The incidence of late hemorrhage in cerebral aneurysm: a 10-year evaluation of 364 patients. Ann Neurol 1:358–370, 1977

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  • 17.

    Winn HR, , Richardson AE, & O'Brien W, et al: The longterm prognosis in untreated cerebral aneurysms: II. Late morbidity and mortality. Ann Neurol 4:418426, 1978 Winn HR, Richardson AE, O'Brien W, et al: The longterm prognosis in untreated cerebral aneurysms: II. Late morbidity and mortality. Ann Neurol 4:418–426, 1978

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  • 18.

    Winn HR, , Taylor J, & Kaiser DL: Prevalence of asymptomatic incidental aneurysms: review of 4,568 arteriograms. Stroke 14:121, 1983 (Abstract) Winn HR, Taylor J, Kaiser DL: Prevalence of asymptomatic incidental aneurysms: review of 4,568 arteriograms. Stroke 14:121, 1983 (Abstract)

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