Treatment of the association of arteriovenous malformation and cerebral aneurysms]

The association of an arteriovenous malformation (AVM) and a cerebral aneurysm is not so rare. Many reports have analyzed its localized relationship and studied hemodynamically the development of the cerebral aneurysm. However its therapeutic measures have not been established so far. At this time, authors have experienced 9 cases of AVM associated with cerebral aneurysm, and have studied suitable therapeutic measures. All 9 cases developed with intracranial hemorrhage, and in 6 of 9 cases, cerebral aneurysm was recognized in the feeding arteries or feeding system of the AVM (Group I). In the other 3 cases, localization of cerebral aneurysm was hemodynamically considered to have less of a relationship with AVM (Group II). It was characteristic that cerebral aneurysm in Group I was multiple, and developed frequently in the peripheral regions of the cerebral artery, especially in feeding system of the AVM itself. An operation was carried out in all 9 cases, and in Group I, 2 of 6 cases were operated on in one stage. The other 4 cases because of difficulty of management in the same operative field, were divided into two stages. In cases with clearly hemorrhagic sources, operation was firstly performed on the hemorrhagic source, and its residual focus was operated on after several months. However, in cases with unknown hemorrhagic source, cerebral aneurysm existing on the proximal side was operated on firstly. On the other hand, in Group II, when the operation was performed at one or two stages, the hemorrhagic source was dealt with first.(ABSTRACT TRUNCATED AT 250 WORDS)