Abstract
During the past 17 years, we have experienced 173 cases of AVMs. Among these, 15 cases (8.7%) were associated with aneurysms. All aneurysms were located in typical proximal arteries such as main feeding arteries or the circle of Willis and were hemodynamically related to an AVM. There were seven cases of subarachnoid hemorrhage and one case of intraparenchymal hemorrhage. The remaining seven were examined because of unconsciousness, seizure and/or hemiparesis. Nine of the 15 patients underwent surgery. In one case the procedure was directed toward the aneurysm alone, in two cases toward the AVM and in six cases toward both lesions.
Surgery should first concentrate on the ruptured lesion. However, in some cases it was hard to make preoperative diagnosis of the ruptured lesion. Also, it is desirable to treat the AVM and the aneurysm in one operation. We experienced a case where total excision of the AVM alone resulted in the disappearance of the aneurysms. Even in an unresectable AVM with a non-ruptured aneurysm, it is preferable to clip the aneurysm to prevent bleeding.
In two cases with an unresectable AVM, a newly formed aneurysm was discovered in the follow-up angiogram, emphasizing that serious follow-up angiography is required for untreated AVMs.
