The incidence of infratentorial arteriovenous malformation-associated aneurysms: an institutional case series and systematic literature review

Mark Davison; Maximos McCune; Nishanth Thiyagarajah; Ahmed Kashkoush; Rebecca Achey; Michael Shost; Gabor Toth; Mark Bain; Nina Moore

doi:10.1136/jnis-2024-022003

The incidence of infratentorial arteriovenous malformation-associated aneurysms: an institutional case series and systematic literature review

J Neurointerv Surg. 2024 Jun 27:jnis-2024-022003. doi: 10.1136/jnis-2024-022003. Online ahead of print.

Authors

Mark Davison¹, Maximos McCune², Nishanth Thiyagarajah², Ahmed Kashkoush³, Rebecca Achey³, Michael Shost⁴, Gabor Toth², Mark Bain^{3

2}, Nina Moore^{3

2

5}

Affiliations

¹ Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA davisom@ccf.org.
² Cerebrovascular Center, CCF, Cleveland Heights, Ohio, USA.
³ Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
⁴ Case Western Reserve University School of Medicine, Cleveland, OH, USA.
⁵ Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA.

PMID: 38937081
DOI: 10.1136/jnis-2024-022003

Abstract

Background: Arteriovenous malformation (AVM)-associated aneurysms represent a high-risk feature predisposing them to rupture. Infratentorial AVMs have been shown to have a greater incidence of associated aneurysms, however the existing data is outdated and biased. The aim of our research was to compare the incidence of supratentorial vs infratentorial AVM-associated aneurysms.

Methods: Patients were identified from our institutional AVM registry, which includes all patients with an intracranial AVM diagnosis since 2000, regardless of treatment. Records were reviewed for clinical details, AVM characteristics, nidus location (supratentorial or infratentorial), and presence of associated aneurysms. Statistical comparisons were made using Fisher's exact or Wilcoxon rank sum tests as appropriate. Multivariable logistic regression analysis determined independent predictors of AVM-associated aneurysms. As a secondary analysis, a systematic literature review was performed, where studies documenting the incidence of AVM-associated aneurysms stratified by location were of interest.

Results: From 2000-2024, 706 patients with 720 AVMs were identified, of which 152 (21.1%) were infratentorial. Intracranial hemorrhage was the most common AVM presentation (42.1%). The incidence of associated aneurysms was greater in infratentorial AVMs compared with supratentorial cases (45.4% vs 20.1%; P<0.0001). Multivariable logistic regression demonstrated that infratentorial nidus location was the singular predictor of an associated aneurysm, odds ratio: 2.9 (P<0.0001). Systematic literature review identified eight studies satisfying inclusion criteria. Aggregate analysis indicated infratentorial AVMs were more likely to harbor an associated aneurysm (OR 1.7) and present as ruptured (OR 3.9), P<0.0001.

Conclusions: In this modern consecutive patient series, infratentorial nidus location was a significant predictor of an associated aneurysm and hemorrhagic presentation.

Keywords: Aneurysm; Angiography; Arteriovenous Malformation; Hemorrhage; Posterior fossa.