Surgical Management for Cases of Intracranial Arteriovenous Malformations Associated with Cerebral Aneurysms

Abstract

We have experienced 83 cases of intracranial arteriovenous malformations(AVMs) during the last five years, from August, 1982 to August, 1987, and 11 cases(13.3%) were associated with cerebral aneurysms. Totally 17 aneurysms were associated with AVMs including four cases of multiple aneurysms. Tweleve aneurysms were located in typical proximal sites or in abnormal distal locations along the feeding system to the AVMs, and the other five were located in sites remote and apparently hemodynamically unrelated to the AVMs. Six patients(55%) presented subarachnoid hemorrhage, diagnosed by CT scans and operative findings; four patients bled from an aneurysm, one patient from the AVM, and in one patient the source of bleeding was unknown. CT scans could not detect the bleeding source in two patients. Surgical treatment was performed in eight cases. Four cases were treated for aneurysms only, and four cases were treated for the combination of lesions. One-stage operation was performed in three of the four cases and two-stage operation in one case. All aneurysms were treated before the resection of the combined AVMs to avoid aneurysmal bleeding caused by the hemodynamic changes associated with the abrupt removal of the AVMs.
Our experience and that reported in the literature led us to decide that every patient with this combination of lesions should have the aneurysm treated first. Exceptions to this principle are cases of large intracerebral hematomas from AVMs, or patients with hemodynamically unrelated remote aneurysms.