抄録
The association of an arteriovenous malformation (AVM) with an intracranial aneurysm has been reported repeatedly, and its association with multiple aneurysms has also been reported sporadically. The authors described such a case, in which surgical intervention prompted the rupture of an aneurysm. The patient, a 47-year-old businessman, suddenly lost consciousness on his way to his office. He was admitted the next day with clinical findings of severe neck stiffness, loss of memory, and right hemiparesis. Cerebral angiography demonstrated 3 aneurysms and 1 AVM. Left frontal craniotomy was performed. During resection of the AVM, massive arterial hemorrhage from a middle cerebral aneurysm occurred, which necessitated clipping of the aneurysm before removal of the AVM. Postoperative angiography showed the disappearance of the AVM and of the middle cerebral aneurysm. The patient was discharged with moderate disability (Glasgow Outcome Scale).
Associated AVM and aneurysm should both be treated surgically, preferably in one operative stage. The aneurysm should be treated first, if it is the source of hemorrhage. It should be treated first, if it lies proximally to the AVM, even if the source of hemorrhage is unclear or the source is the AVM. The AVM should be removed in advance of the aneurysm only when both lesions are situated in different arterial regions and the AVM is the source of hemorrhage.
