T Clinical Experience of Arteriovenous Malformation with Extranidal Aneurysms / 대한뇌혈관외과학회지

ABSTRACT

OBJECTIVE: The presence of intracranial arteriovenous malformation (AVM) with extranidal aneurysms has been well documented. Attention has been focused on the most appropriate treatment of patients harboring these lesions. The authors analyzed the clinical features, characteristics, and treatment modalities of these lesions based on clinical experiences. METHODS: Between 1996 and 2003, 21 consecutive patients were diagnosed and treated for AVMs associated with extranidal aneurysms (1 patient with intra and extranidal aneurysm). The medical records and neuroimaging studies of the patients were reviewed retrospectively. RESULTS: There were 18 patients with flow-related extranidal aneurysms, 3 patients with flow-unrelated ones. Fifteen (71.4%) of 21 patients presented with intracranial hemorrhage (subarachnoid hemorrhage 10, intracerebral hemorrhge or intraventricular hemorrhage 5) as initial symptom upon admission. Six (28.6%) of 21 patients were admitted with other symptom rather than hemorrhage (3 seizure, 1 headache, 1 TIA, 1 incidental). Fifteen (71.4%) of 21 cases was located predominantly in posterior circulation. We observed that 7 (33.3%) patients experienced subsequent hemorrhage during management. We tried to secure aneurysm initially regardless of presented sypmtoms in most of them. Treatment modalities included surgery, gamma knife radiosurgery, embolization, or combination. Most of cases were treated with combination therapy except 3 patients. CONCLUSIONS: There was a great propensity to hemorrhage, especially extranidal aneurysmal ruture, in patients with AVM associated with extranidal aneurysms. Symptomatic treatment should be considered initially. Owing to increased possible risk of hemorrhage, patients harboring these lesions should be cared aggressively to prevent bleeding.