An analysis of the venous drainage system as a factor in hemorrhage from arteriovenous malformations

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  • 1 Department of Neurosurgery and Acute Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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✓ The authors studied the venous drainage system and its impairment in relation to risk of hemorrhage in 108 cases of supratentorial arteriovenous malformation (AVM). The proportion of AVM's undergoing hemorrhage (hemorrhagic rate) was calculated in relation to: 1) the number of draining veins (one, two, or three or more); 2) the presence or absence of impairment in venous drainage (severe stenosis or occlusion in draining veins); and 3) the location of draining veins (deep venous drainage alone, superficial venous drainage alone, or a combination of the two). Statistical analysis demonstrated that AVM's with the following characteristics had a high risk of hemorrhage: 1) one draining vein (hemorrhagic rate 89% in 54 patients); 2) severely impaired venous drainage (hemorrhagic rate 94% in 18 patients); and 3) deep venous drainage alone (hemorrhagic rate 94% in 32 patients).

The present study suggests that the venous drainage system of AVM's is significantly associated with the risk of hemorrhage of these lesions. Therefore, careful preoperative angiographic evaluation of the venous drainage system is mandatory for decision making in the management of patients with AVM's.

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Contributor Notes

Address reprint requests to: Yoshio Miyasaka, M.D., Department of Neurosurgery, Kitasato University School of Medicine, 1–15–1 Sagamihara, Kanagawa 228, Japan.
  • 1.

    Albert P, , Salgado H, & Polaina M, et al: A study on the venous drainage of 150 cerebral arteriovenous malformations as related to haemorrhagic risks and size of the lesion. Acta Nenrochir 103:3034, 1990 Albert P, Salgado H, Polaina M, et al: A study on the venous drainage of 150 cerebral arteriovenous malformations as related to haemorrhagic risks and size of the lesion. Acta Nenrochir 103:30–34, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Brown RD Jr, , Wiebers DO, & Forbes G, et al: The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 68:352357, 1988 Brown RD Jr, Wiebers DO, Forbes G, et al: The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 68:352–357, 1988

    • Search Google Scholar
    • Export Citation
  • 3.

    Graf CJ, , Perret GE, & Tomer JC: Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 58:331337, 1983 Graf CJ, Perret GE, Tomer JC: Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 58:331–337, 1983

    • Search Google Scholar
    • Export Citation
  • 4.

    Guidetti B, & Delitala A: Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 53:149152, 1980 Guidetti B, Delitala A: Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 53:149–152, 1980

    • Search Google Scholar
    • Export Citation
  • 5.

    Marks MP, , Lane B, & Steinberg GK, et al: Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants. Radiology 176:807813, 1990 Marks MP, Lane B, Steinberg GK, et al: Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants. Radiology 176:807–813, 1990

    • Search Google Scholar
    • Export Citation
  • 6.

    Nornes H, & Grip A: Hemodynamic aspects of cerebral arteriovenous malformations. J Neurosurg 53:456464, 1980 Nornes H, Grip A: Hemodynamic aspects of cerebral arteriovenous malformations. J Neurosurg 53:456–464, 1980

    • Search Google Scholar
    • Export Citation
  • 7.

    Parkinson D, & Bachers G: Arteriovenous malformations. Summary of 100 consecutive supratentorial cases. J Neurosurg 53:285299, 1980 Parkinson D, Bachers G: Arteriovenous malformations. Summary of 100 consecutive supratentorial cases. J Neurosurg 53:285–299, 1980

    • Search Google Scholar
    • Export Citation
  • 8.

    Paterson JH, & McKissock W: A clinical survey of intracranial angiomas with special reference to their mode of progression and surgical treatment: a report of 110 cases. Brain 79:233266, 1956 Paterson JH, McKissock W: A clinical survey of intracranial angiomas with special reference to their mode of progression and surgical treatment: a report of 110 cases. Brain 79:233–266, 1956

    • Search Google Scholar
    • Export Citation
  • 9.

    Pellettieri L: Surgical versus conservative treatment of intracranial arteriovenous malformations. A study in surgical decision-making. Acta Neurochir Suppl 29:186, 1980 Pellettieri L: Surgical versus conservative treatment of intracranial arteriovenous malformations. A study in surgical decision-making. Acta Neurochir Suppl 29:1–86, 1980

    • Search Google Scholar
    • Export Citation
  • 10.

    Viñuela F, , Nombela L, & Roach MR, et al: Stenotic and occlusive disease of the venous drainage system of deep brain AVM's. J Neurosurg 63:180184, 1985 Viñuela F, Nombela L, Roach MR, et al: Stenotic and occlusive disease of the venous drainage system of deep brain AVM's. J Neurosurg 63:180–184, 1985

    • Search Google Scholar
    • Export Citation
  • 11.

    Waltimo O: The relationship of size, density and localization of intracranial arteriovenous malformations to type of initial symptoms. J Neurol Sci 19:1319, 1973 Waltimo O: The relationship of size, density and localization of intracranial arteriovenous malformations to type of initial symptoms. J Neurol Sci 19:13–19, 1973

    • Search Google Scholar
    • Export Citation
  • 12.

    Willinsky R, , Lasjaunias P, & Terbrugge K, et al: Brain arteriovenous malformations: analysis of the angio-archi-tecture in relationship to hemorrhage (based on 152 patients explored and/or treated at the Hôpital de Bicétre between 1981 and 1986). J Neuroradiol 15:225237, 1988 Willinsky R, Lasjaunias P, Terbrugge K, et al: Brain arteriovenous malformations: analysis of the angio-archi-tecture in relationship to hemorrhage (based on 152 patients explored and/or treated at the Hôpital de Bicétre between 1981 and 1986). J Neuroradiol 15:225–237, 1988

    • Search Google Scholar
    • Export Citation
  • 13.

    Yaşargil MG: Intracranial AVM with stenosis and occlusion of major vessels, in Yaşargil MG (ed): Microneuro-surgery, IIIA. New York: Georg Thieme Verlag, 1987, pp 190195 Yaşargil MG: Intracranial AVM with stenosis and occlusion of major vessels, in Yaşargil MG (ed): Microneuro-surgery, IIIA. New York: Georg Thieme Verlag, 1987, pp 190–195

    • Search Google Scholar
    • Export Citation

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