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Updated: Apr 25, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Natural history of brain arteriovenous malformations: a systematic review
Isaac Josh Abecassis1, David S Xu, H Hunt Batjer
1Department of Neurological Surgery, University of Washington, Seattle, Washington.
Insights
The natural history of brain arteriovenous malformations (BAVMs) shows an annual hemorrhage risk of 2.10%-4.12%. Specific features like initial presentation and location influence rupture risk for BAVMs.
Area of Science:
- Neurology
- Vascular Surgery
- Neurosurgery
Background:
- Brain arteriovenous malformations (BAVMs) are complex vascular lesions.
- Understanding the natural history of BAVMs is crucial for patient management.
- Hemorrhage is a primary concern in the natural course of BAVMs.
Purpose of the Study:
- To systematically review existing literature on the natural history of BAVMs.
- To clarify the incidence and annual hemorrhage rates associated with BAVMs.
- To identify factors influencing the risk of rupture in BAVMs.
Main Methods:
- A comprehensive PubMed search was conducted using keywords related to BAVMs and their natural history.
- Studies included reported annual hemorrhage rates and had at least 100 patients or 5 years of follow-up.
- Inclusion criteria focused on quantifying rupture risk and identifying associated factors.
Main Results:
- The incidence of BAVMs is estimated at 1.12-1.42 per 100,000 person-years.
- 38%-68% of BAVM cases present as a first-ever hemorrhage.
- The overall annual hemorrhage rate for untreated BAVMs ranges from 2.10% to 4.12%.
Conclusions:
- The annual risk of hemorrhage for BAVMs is between 2.10% and 4.12%.
- Factors such as initial presentation, venous drainage, and location significantly impact rupture risk.
- Accurate risk assessment for BAVMs requires careful clinical evaluation of specific malformation features.
Object:
The authors aimed to systematically review the literature to clarify the natural history of brain arteriovenous malformations (BAVMs).
Methods:
The authors searched PubMed for one or more of the following terms: natural history, brain arteriovenous malformations, cerebral arteriovenous malformations, and risk of rupture. They included studies that reported annual rates of hemorrhage and that included either 100 patients or 5 years of treatment-free follow-up.
Results:
The incidence of BAVMs is 1.12-1.42 cases per 100,000 person-years; 38%-68% of new cases are first-ever hemorrhage. The overall annual rates of hemorrhage for patients with untreated BAVMs range from 2.10% to 4.12%. Consistently implicated in subsequent hemorrhage are initial hemorrhagic presentation, exclusively deep venous drainage, and deep and infrantentorial brain location. The risk for rupture seems to be increased by large nidus size and concurrent arterial aneurysms, although these factors have not been studied as thoroughly. Venous stenosis has not been implicated in increased risk for rupture.
Conclusions:
For patients with BAVMs, although the overall risk for hemorrhage seems to be 2.10%-4.12% per year, calculating an accurate risk profile for decision making involves clinical attention and accounting for specific features of the malformation.
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