title: Hemorrhage risk and clinical features of multiple intracranial arteriovenous malformations.
abstract: The aim of this report is to examine clinical characteristics, treatment strategies, and annual hemorrhage incidence rate for patients with multiple arteriovenous malformations (MAVM). The PubMed and EMBASE databases and the arteriovenous malformations (AVM) database at The Johns Hopkins Hospital were searched to identify patients with MAVM. Data related to demographics, clinical features, management, and treatment outcomes were analyzed with descriptive statistics. Thirty-eight patients met the inclusion criteria. The annual hemorrhage incidence rate was 6.7%. Surgical intervention remained the most common single-modality treatment from 1949-2011. Between 1990 and 2011, multiple-modality treatment strategies (36% of cases) were employed more frequently. The most common presenting features were neurological deficit (74%) and hemorrhage (63%). In patients undergoing staged treatment of MAVM, hemorrhage of an untreated nidus (n=5), visualization of a new nidus (n=9), and disappearance of an untreated nidus (n=2) were observed. Limitations of this study include small sample size and reporting bias. The annual hemorrhage incidence rate for MAVM patients was approximately two- to three-fold greater than the reported annual hemorrhage rates for solitary AVM. Combining different treatment modalities has become the most common management strategy. The potential instability of remaining nidi with staged or incomplete treatment necessitates close follow-up in these cases.
authors.affiliation: Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Boone
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Caplan
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA.
authors.forename: Wuyang
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA.
authors.forename: Xiaobu
authors.initials: X
authors.lastname: Ye
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA.
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Colby
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Coon
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA.
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Tamargo
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Zayed 6115F, Baltimore, MD 21287, USA. Electronic address: jhuang24@jhmi.edu.
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000601:surgery; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged
keywords: Arteriovenous malformation; Hemorrhage; Multiple arteriovenous malformations; Treatment trends