{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T19:53:26Z","timestamp":1788378806326,"version":"build-2803163510"},"reference-count":82,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,9]]},"abstract":"\n Object<\/jats:title>\n The authors aimed to systematically review the literature to clarify the natural history of brain arteriovenous malformations (BAVMs).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The incidence of BAVMs is 1.12\u20131.42 cases per 100,000 person-years; 38%\u201368% 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n For patients with BAVMs, although the overall risk for hemorrhage seems to be 2.10%\u20134.12% per year, calculating an accurate risk profile for decision making involves clinical attention and accounting for specific features of the malformation.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.6.focus14250","type":"journal-article","created":{"date-parts":[[2014,9,1]],"date-time":"2014-09-01T03:40:04Z","timestamp":1409542804000},"page":"E7","source":"Crossref","is-referenced-by-count":176,"title":["Natural history of brain arteriovenous malformations: a systematic review"],"prefix":"10.3171","volume":"37","author":[{"given":"Isaac Josh","family":"Abecassis","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Xu","sequence":"additional","affiliation":[{"name":"Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Hunt","family":"Batjer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard R.","family":"Bendok","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery, Radiology, and Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0370007","series-title":"Stroke","first-page":"1163","article-title":"Prospective, population-based detection of intracranial vascular malformations in adults: the Scottish Intracranial Vascular Malformation Study (SIVMS)","volume":"34","author":"Al-Shahi","year":"2003"},{"key":"b2-0370007","series-title":"Stroke","first-page":"2794","article-title":"A population-based study of brain arteriovenous malformation: long-term treatment outcomes","volume":"33","author":"ApSimon","year":"2002"},{"key":"b3-0370007","series-title":"J Neurosurg","first-page":"352","article-title":"The natural history of unruptured intracranial arteriovenous malformations","volume":"68","author":"Brown","year":"1988"},{"key":"b4-0370007","series-title":"J Neurosurg","first-page":"29","article-title":"Frequency of intracranial hemorrhage as a presenting symptom and subtype analysis: a population-based study of intracranial vascular malformations in Olmsted Country, Minnesota","volume":"85","author":"Brown","year":"1996"},{"key":"b5-0370007","series-title":"Neurology","first-page":"949","article-title":"Incidence and prevalence of intracranial vascular malformations in Olmsted County, Minnesota, 1965 to 1992","volume":"46","author":"Brown","year":"1996"},{"key":"b6-0370007","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1","article-title":"Arteriovenous malformations of the brain: natural history in unoperated patients","volume":"49","author":"Crawford","year":"1986"},{"key":"b7-0370007","series-title":"Stroke","first-page":"100","article-title":"The natural history and predictive features of hemorrhage from brain arteriovenous malformations","volume":"40","author":"da Costa","year":"2009"},{"key":"b8-0370007","series-title":"Stroke","first-page":"2099","article-title":"Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations","volume":"36","author":"Fullerton","year":"2005"},{"key":"b9-0370007","series-title":"Neurosurgery","first-page":"658","article-title":"Natural history of arteriovenous malformations of the brain: a clinical study","volume":"15","author":"Fults","year":"1984"},{"key":"b10-0370007","series-title":"Stroke","first-page":"21","article-title":"Ten-year detection rate of brain arteriovenous malformations in a large, multiethnic, defined population","volume":"41","author":"Gabriel","year":"2010"},{"key":"b11-0370007","series-title":"J Neurosurg","first-page":"331","article-title":"Bleeding from cerebral arteriovenous malformations as part of their natural history","volume":"58","author":"Graf","year":"1983"},{"key":"b12-0370007","series-title":"J Neurosurg","first-page":"437","article-title":"Natural history of cerebral arteriovenous malformations: a meta-analysis. Clinical article","volume":"118","author":"Gross","year":"2013"},{"key":"b13-0370007","series-title":"Stroke","first-page":"1697","article-title":"Longitudinal risk of intracranial hemorrhage in patients with arteriovenous malformation of the brain within a defined population","volume":"35","author":"Halim","year":"2004"},{"key":"b14-0370007","series-title":"Neurosurgery","first-page":"823","article-title":"Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients","volume":"63","author":"Hernesniemi","year":"2008"},{"key":"b15-0370007","series-title":"J Neurosurg","first-page":"633","article-title":"Population-based analysis of arteriovenous malformation treatment","volume":"95","author":"Hillman","year":"2001"},{"issue":"Suppl","key":"b16-0370007","series-title":"Neurol Med Chir (Tokyo)","first-page":"165","article-title":"Angioarchi-tecture related to hemorrhage in cerebral arteriovenous malformations","volume":"38","author":"Hirai","year":"1998"},{"key":"b17-0370007","series-title":"Stroke","first-page":"1307","article-title":"Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation","volume":"31","author":"Hofmeister","year":"2000"},{"key":"b18-0370007","series-title":"Clin Neurol Neurosurg","first-page":"193","article-title":"Cerebral arteriovenous malformations in the Netherlands Antilles. High prevalence of hereditary hemorrhagic telangiectasia-related single and multiple cerebral arteriovenous malformations","volume":"95","author":"Jessurun","year":"1993"},{"key":"b19-0370007","series-title":"Stroke","first-page":"1430","article-title":"Reporting terminology for brain arteriovenous malformation clinical and radiographic features for use in clinical trials","volume":"32","author":"Joint Writing Group of the Technology Assessment Committee American Society of Interventional and Therapeutic Neuroradiology","year":"2001"},{"key":"b20-0370007","series-title":"Am J Epidemiol","first-page":"1317","article-title":"Comparison of 2 approaches for determining the natural history risk of brain arteriovenous malformation rupture","volume":"171","author":"Kim","year":"2010"},{"key":"b21-0370007","series-title":"Surgical Management of Cerebrovascular Disease","first-page":"65","article-title":"Natural history of arteriovenous malformations: presentation, risk of hemorrhage and mortality","author":"Laakso"},{"key":"b22-0370007","series-title":"Neurosurgery","first-page":"481","article-title":"Hypertension, small size, and deep venous drainage are associated with risk of hemorrhagic presentation of cerebral arteriovenous malformations","volume":"42","author":"Langer","year":"1998"},{"key":"b23-0370007","series-title":"Neurosurgery","first-page":"272","article-title":"Factors associated with intracranial hemorrhage in cases of cerebral arteriovenous malformation","volume":"46","author":"Mansmann","year":"2000"},{"key":"b24-0370007","series-title":"Radiology","first-page":"807","article-title":"Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants","volume":"176","author":"Marks","year":"1990"},{"key":"b25-0370007","series-title":"Lancet","first-page":"1065","article-title":"Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation","volume":"350","author":"Mast","year":"1997"},{"key":"b26-0370007","series-title":"J Neurosurg","first-page":"807","article-title":"The pathology of vascular (\u201carteriovenous\u201d) malformations","volume":"24","author":"McCormick","year":"1966"},{"key":"b27-0370007","series-title":"J Clin Neurosci","first-page":"503","article-title":"Risk factors for poor outcome of untreated arteriovenous malformation","volume":"7","author":"Mine","year":"2000"},{"key":"b28-0370007","series-title":"J Neurosurg","first-page":"239","article-title":"An analysis of the venous drainage system as a factor in hemorrhage from arteriovenous malformations","volume":"76","author":"Miyasaka","year":"1992"},{"key":"b29-0370007","series-title":"Neuroradiology","first-page":"52","article-title":"Angioarchitecture associated with haemorrhage in cerebral arteriovenous malformations: a prognostic statistical model","volume":"39","author":"Nataf","year":"1997"},{"key":"b30-0370007","series-title":"A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA)","author":"National Institute of Neurological Disorders and Stroke","year":"2013"},{"key":"b31-0370007","series-title":"J Neurosurg","first-page":"456","article-title":"Hemodynamic aspects of cerebral arteriovenous malformations","volume":"53","author":"Nornes","year":"1980"},{"key":"b32-0370007","series-title":"J Neurosurg","first-page":"387","article-title":"The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment","volume":"73","author":"Ondra","year":"1990"},{"key":"b33-0370007","series-title":"Stroke","first-page":"1","article-title":"Factors that predict the bleeding risk of cerebral arteriovenous malformations","volume":"27","author":"Pollock","year":"1996"},{"key":"b34-0370007","series-title":"Stroke","first-page":"e29","article-title":"The New York Islands AVM Study: design, study progress, and initial results","volume":"34","author":"Stapf","year":"2003"},{"key":"b35-0370007","series-title":"Neurology","first-page":"1350","article-title":"Predictors of hemorrhage in patients with untreated brain arteriovenous malformation","volume":"66","author":"Stapf","year":"2006"},{"issue":"5","key":"b36-0370007","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Epidemiology and natural history of arteriovenous malformations","volume":"11","author":"Stapf","year":"2001"},{"key":"b37-0370007","series-title":"Stroke","first-page":"1220","article-title":"Large and deep brain arteriovenous malformations are associated with risk of future hemorrhage","volume":"33","author":"Stefani","year":"2002"},{"key":"b38-0370007","series-title":"Neurosurgery","first-page":"856","article-title":"Correlation of the angioarchitectural features of cerebral arteriovenous malformations with clinical presentation of hemorrhage","volume":"37","author":"Turjman","year":"1995"},{"key":"b39-0370007","series-title":"J Neurosurg","first-page":"180","article-title":"Stenotic and occlusive disease of the venous drainage system of deep brain AVM\u2019s","volume":"63","author":"Vi\u00f1uela","year":"1985"},{"key":"b40-0370007","series-title":"J Neuroradiol","first-page":"225","article-title":"Brain arteriovenous malformations: analysis of the angio-architecture in relationship to hemorrhage (based on 152 patients explored and\/or treated at the hospital de Bicetre between 1981 and 1986)","volume":"15","author":"Willinsky","year":"1988"},{"key":"b41-0370007","series-title":"J Neurosurg","first-page":"965","article-title":"Risk factors for subsequent hemorrhage in patients with cerebral arteriovenous malformations","volume":"107","author":"Yamada","year":"2007"},{"key":"b1-0370007","series-title":"Stroke","first-page":"1163","article-title":"Prospective, population-based detection of intracranial vascular malformations in adults: the Scottish Intracranial Vascular Malformation Study (SIVMS)","volume":"34","author":"Al-Shahi","year":"2003"},{"key":"b2-0370007","series-title":"Stroke","first-page":"2794","article-title":"A population-based study of brain arteriovenous malformation: long-term treatment outcomes","volume":"33","author":"ApSimon","year":"2002"},{"key":"b3-0370007","series-title":"J Neurosurg","first-page":"352","article-title":"The natural history of unruptured intracranial arteriovenous malformations","volume":"68","author":"Brown","year":"1988"},{"key":"b4-0370007","series-title":"J Neurosurg","first-page":"29","article-title":"Frequency of intracranial hemorrhage as a presenting symptom and subtype analysis: a population-based study of intracranial vascular malformations in Olmsted Country, Minnesota","volume":"85","author":"Brown","year":"1996"},{"key":"b5-0370007","series-title":"Neurology","first-page":"949","article-title":"Incidence and prevalence of intracranial vascular malformations in Olmsted County, Minnesota, 1965 to 1992","volume":"46","author":"Brown","year":"1996"},{"key":"b6-0370007","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1","article-title":"Arteriovenous malformations of the brain: natural history in unoperated patients","volume":"49","author":"Crawford","year":"1986"},{"key":"b7-0370007","series-title":"Stroke","first-page":"100","article-title":"The natural history and predictive features of hemorrhage from brain arteriovenous malformations","volume":"40","author":"da Costa","year":"2009"},{"key":"b8-0370007","series-title":"Stroke","first-page":"2099","article-title":"Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations","volume":"36","author":"Fullerton","year":"2005"},{"key":"b9-0370007","series-title":"Neurosurgery","first-page":"658","article-title":"Natural history of arteriovenous malformations of the brain: a clinical study","volume":"15","author":"Fults","year":"1984"},{"key":"b10-0370007","series-title":"Stroke","first-page":"21","article-title":"Ten-year detection rate of brain arteriovenous malformations in a large, multiethnic, defined population","volume":"41","author":"Gabriel","year":"2010"},{"key":"b11-0370007","series-title":"J Neurosurg","first-page":"331","article-title":"Bleeding from cerebral arteriovenous malformations as part of their natural history","volume":"58","author":"Graf","year":"1983"},{"key":"b12-0370007","series-title":"J Neurosurg","first-page":"437","article-title":"Natural history of cerebral arteriovenous malformations: a meta-analysis. Clinical article","volume":"118","author":"Gross","year":"2013"},{"key":"b13-0370007","series-title":"Stroke","first-page":"1697","article-title":"Longitudinal risk of intracranial hemorrhage in patients with arteriovenous malformation of the brain within a defined population","volume":"35","author":"Halim","year":"2004"},{"key":"b14-0370007","series-title":"Neurosurgery","first-page":"823","article-title":"Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients","volume":"63","author":"Hernesniemi","year":"2008"},{"key":"b15-0370007","series-title":"J Neurosurg","first-page":"633","article-title":"Population-based analysis of arteriovenous malformation treatment","volume":"95","author":"Hillman","year":"2001"},{"issue":"Suppl","key":"b16-0370007","series-title":"Neurol Med Chir (Tokyo)","first-page":"165","article-title":"Angioarchi-tecture related to hemorrhage in cerebral arteriovenous malformations","volume":"38","author":"Hirai","year":"1998"},{"key":"b17-0370007","series-title":"Stroke","first-page":"1307","article-title":"Demographic, morphological, and clinical characteristics of 1289 patients with brain arteriovenous malformation","volume":"31","author":"Hofmeister","year":"2000"},{"key":"b18-0370007","series-title":"Clin Neurol Neurosurg","first-page":"193","article-title":"Cerebral arteriovenous malformations in the Netherlands Antilles. High prevalence of hereditary hemorrhagic telangiectasia-related single and multiple cerebral arteriovenous malformations","volume":"95","author":"Jessurun","year":"1993"},{"key":"b19-0370007","series-title":"Stroke","first-page":"1430","article-title":"Reporting terminology for brain arteriovenous malformation clinical and radiographic features for use in clinical trials","volume":"32","author":"Joint Writing Group of the Technology Assessment Committee American Society of Interventional and Therapeutic Neuroradiology","year":"2001"},{"key":"b20-0370007","series-title":"Am J Epidemiol","first-page":"1317","article-title":"Comparison of 2 approaches for determining the natural history risk of brain arteriovenous malformation rupture","volume":"171","author":"Kim","year":"2010"},{"key":"b21-0370007","series-title":"Surgical Management of Cerebrovascular Disease","first-page":"65","article-title":"Natural history of arteriovenous malformations: presentation, risk of hemorrhage and mortality","author":"Laakso"},{"key":"b22-0370007","series-title":"Neurosurgery","first-page":"481","article-title":"Hypertension, small size, and deep venous drainage are associated with risk of hemorrhagic presentation of cerebral arteriovenous malformations","volume":"42","author":"Langer","year":"1998"},{"key":"b23-0370007","series-title":"Neurosurgery","first-page":"272","article-title":"Factors associated with intracranial hemorrhage in cases of cerebral arteriovenous malformation","volume":"46","author":"Mansmann","year":"2000"},{"key":"b24-0370007","series-title":"Radiology","first-page":"807","article-title":"Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants","volume":"176","author":"Marks","year":"1990"},{"key":"b25-0370007","series-title":"Lancet","first-page":"1065","article-title":"Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation","volume":"350","author":"Mast","year":"1997"},{"key":"b26-0370007","series-title":"J Neurosurg","first-page":"807","article-title":"The pathology of vascular (\u201carteriovenous\u201d) malformations","volume":"24","author":"McCormick","year":"1966"},{"key":"b27-0370007","series-title":"J Clin Neurosci","first-page":"503","article-title":"Risk factors for poor outcome of untreated arteriovenous malformation","volume":"7","author":"Mine","year":"2000"},{"key":"b28-0370007","series-title":"J Neurosurg","first-page":"239","article-title":"An analysis of the venous drainage system as a factor in hemorrhage from arteriovenous malformations","volume":"76","author":"Miyasaka","year":"1992"},{"key":"b29-0370007","series-title":"Neuroradiology","first-page":"52","article-title":"Angioarchitecture associated with haemorrhage in cerebral arteriovenous malformations: a prognostic statistical model","volume":"39","author":"Nataf","year":"1997"},{"key":"b30-0370007","series-title":"A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA)","author":"National Institute of Neurological Disorders and Stroke","year":"2013"},{"key":"b31-0370007","series-title":"J Neurosurg","first-page":"456","article-title":"Hemodynamic aspects of cerebral arteriovenous malformations","volume":"53","author":"Nornes","year":"1980"},{"key":"b32-0370007","series-title":"J Neurosurg","first-page":"387","article-title":"The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment","volume":"73","author":"Ondra","year":"1990"},{"key":"b33-0370007","series-title":"Stroke","first-page":"1","article-title":"Factors that predict the bleeding risk of cerebral arteriovenous malformations","volume":"27","author":"Pollock","year":"1996"},{"key":"b34-0370007","series-title":"Stroke","first-page":"e29","article-title":"The New York Islands AVM Study: design, study progress, and initial results","volume":"34","author":"Stapf","year":"2003"},{"key":"b35-0370007","series-title":"Neurology","first-page":"1350","article-title":"Predictors of hemorrhage in patients with untreated brain arteriovenous malformation","volume":"66","author":"Stapf","year":"2006"},{"issue":"5","key":"b36-0370007","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Epidemiology and natural history of arteriovenous malformations","volume":"11","author":"Stapf","year":"2001"},{"key":"b37-0370007","series-title":"Stroke","first-page":"1220","article-title":"Large and deep brain arteriovenous malformations are associated with risk of future hemorrhage","volume":"33","author":"Stefani","year":"2002"},{"key":"b38-0370007","series-title":"Neurosurgery","first-page":"856","article-title":"Correlation of the angioarchitectural features of cerebral arteriovenous malformations with clinical presentation of 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