Intracranial aneurysms associated with arteriovenous malformations

Posterior fossa arteriovenous malformations

The authors report their treatment of 66 infratentorial arteriovenous malformations (AVM's) in patients aged 5 to 69 years. Sixty-one of them presented with hemorrhage, three with headache, and two with focal neurological deficits. Five patients underwent surgical exploration only, one was treated with ventriculostomy, three had ligation of the AVM feeding arteries, four underwent intraoperative embolization, and two had pontine hematomas removed; complete excision was attempted in 51 patients and accomplished in 47. Twelve of the patients also had aneurysms (nine of which had ruptured). Of this series, 71% had a good result, 14% a poor result, and 15% died. Most of the operative morbidity was due to massive postoperative hemorrhage, probably related to inadequate hemostasis.

Posterior inferior cerebellar artery aneurysm associated with arteriovenous malformation fed by the same artery

A 37-year-old man presented with a peripheral aneurysm of the left posterior inferior cerebellar artery associated with a more peripheral arteriovenous malformation fed by the same artery. Recurrent subarachnoid hemorrhage occurred from rupture of the aneurysm. Review of the pertinent literature indicates that the aneurysm of the posterior inferior cerebellar artery originates from the peripheral portion of the artery, when associated with arteriovenous malformation.

Association of arteriovenous malformation and intracranial aneurysm in the posterior fossa

Two cases of a saccular aneurysm of the posterior inferior cerebellar artery associated with an anatomically related arteriovenous malformation are presented. The aneurysms were clipped and the arteriovenous malformations were totally extirpated in one-stage operations in both cases. The association of arteriovenous malformation and arterial aneurysm in the posterior fossa was reviewed in the literature.

Location of intracranial aneurysms associated with cerebral arteriovenous malformation: statistical analysis

Distributions of cerebral aneurysms by site were compared statistically in 78 reported cases associated with arteriovenous malformation, including our five cases, and cases with solitary intracranial aneurysms without arteriovenous malformation. When the feeder of an arteriovenous malformation was one of the branches of anterior, middle, or posterior cerebral arteries, the aneurysms were located on these respective arteries much more frequently than expected in the general aneurysmal population. This was statistically significant. Our results strongly suggest that abnormal hemodynamic stresses on the arteries from which the feeders branch out to arteriovenous malformations play a significant role in the development of intracranial aneurysms on these arteries.

Arteriovenous malformation and a ruptured giant aneurysm cured by emergency operation in a child

An arteriovenous malformation with a giant aneurysm and an intracerebral hemorrhage in a 3-year-old girl is reported. The malformation, the ruptured giant aneurysm, and the hematoma were totally and successfully removed during an emergency operation with temporary occlusion of the feeding artery and administration of 20% mannitol to prolong the permissive occlusion time of the cerebral arteries.

Coexistence of bilateral aneurysms of the internal carotid arteries and an arteriovenous malformation of the left frontal lobe

A 44-year-old right-handed man was hospitalized because of a subarachnoid hemorrhage. He was drowsy on admission and exhibited a left partial third nerve palsy, right hemiparesis, and selective motor aphasia. A large subcortical arteriovenous malformation involving the left frontal lobe was demonstrated by angiography. The malformation filled from either carotid system and from the vertebrobasilar system as well. In addition, there were two bilaterally symmetrical (mirror) aneurysms of each internal carotid artery. Computed axial tomography revealed a left intratemporal-intraventricular hematoma. Deterioration of the patient's clinical condition occurred a few days after admission. Improvement was obtained after removal of the hematoma at a left subtemporal craniectomy, at which time the ruptured aneurysm arising from the left internal carotid artery was clipped. Sixteen months later, the intact aneurysm of the right internal carotid artery was clipped, and the arteriovenous malformation was radically excised through a bifrontal (Pool) craniotomy with microsurgical technique and with the aid of intraoperative angiography. The patient remained with a fixed neurological deficit, as observed preoperatively.

Aneurysm growth and hemodynamic stress

Two cases of intracranial saccular aneurysm related to an arteriovenous malformation (AVM) are illustrated, in which a remarkable growth of the sac over the years was demonstrated angiographically. According to the relevant literature, aneurysm enlargement is correlated to the flow toward the AVM, increasing the intrasaccular turbulence and stress on the wall to which "solitary" aneurysms are usually subjected. The presence of bilateral infundibular widening at the origin of the posterior communicating artery is noted in one of the cases. This finding possibly confirms further the effects of hemodynamic stress.

Association of intracranial aneurysm and arteriovenous malformation

In a series of 252 patients (47 with arteriovenous malformation, 205 with aneurysms), two patients had a coexisting intracranial aneurysm and an arteriovenous malformation. In one patient, the aneurysm was proximal to the main feeding arteries of the arteriovenous malformation. In the other patient, there was no anatomical relationship between the two lesions. These findings illustrate different views on the pathogenesis of the rare association of the two conditions.

The association of cerebral aneurysms, infundibula, and intracranial arteriovenous malformations

Intracranial arteriovenous malformations (AVMs) are congenital communications between the cerebral arteries and veins without an intervening capillary network. The association of the malformations with other vascular lesions such as intracranial aneurysms has previously been reported. We have reviewed 132 consecutive patients with intracranial AVMs evaluated angiographically at New England Medical Center. In addition to the expected high incidence of saccular aneurysms, a high incidence of arterial infundibula was found. A review of the association between the AVMs, aneurysms and infundibula, and possible etiologic factors in the relationship forms the subject of this report.