1988 Volume 16 Issue 2 Pages 113-117
Sixteen cases of cerebral aneurysms associated with intracranial arteriovenous malformations (AVMs) have been found in these hospitals. The mechanism of the development of these aneurysms in this combination of intracranial vascular lesions has been documented by many previous authors. However, less attention has been focused on the most appropriate surgical management of these patients.
We report on 16 patients with both lesions (aneurysms and AVMs), and discuss the therapeutic problems of this type of lesion.
The following are our conclusions: 1) We have treated 116 cases of AVMs, 16 of which (14%) were associated with cerebral aneurysms. The rate of this combination of intracranial vascular lesions is not small. Therefore, precise preoperative neuroradiological examinations should be made to confirm the presence or absence of aneurysms in all patients with cerebral AVMs. We must carefully consider whether the two lesions may be located separately, for example, one lesions exists supratentorially, and the other is located infratentorially.
2) Preoperative diagnosis of the source of hemorrhage is necessary to decide the priority of surgical procedure, especially when the lesions are located separately. The advent of CT (computerized tomographic) scanning has made it easier to detect the source of hemorrhage. However, it is often difficult to correctly locate the source in many patients at the chronic stage of hemorrhage, and in a few patients at the acute stage.
3) In patients hemorrhaging from whatever source, when aneurysms and AVMs are located close together, both lesions can be treated in a sigle operation. However, when they are located separately, the priority of surgical procedure should be directed to the source of hemorrhage. when the source is unclear, cerebral aneurysms should be clipped first.
4) From the present study, we were unable to conclude whether or not unruptured aneurysms associated with AVMs should be operated on.
