There have been several attempts to categorize AVM-related aneurysms,4,5,9,15,17,21,24,26,27 but a widely accepted system of classification based on their anatomical and pathophysiological relationship to the AVM has yet to be developed and validated. Ideally, such a system of classification would have predictive value with respect to the risk of future hemorrhage, as well as to the potential impact of hemodynamic changes resulting from AVM treatment on associated saccular aneurysms. Most publications have dealt with descriptive aspects of these associated lesions, whereas less emphasis has been placed on appropriate surgical and endovascular management priorities.
An imperfect understanding of the relationship between AVMs and associated aneurysms has led to widely varying treatment strategies. Concern that abrupt elimination of an AVM might put aneurysms located along feeding arteries at immediate risk of distention and subsequent rupture has led some to recommend treating the aneurysm before the AVM.2 Alternatively, the reduction of flow through feeding arteries following AVM elimination has prompted others to recommend elimination of the AVM first, with the expectation that resulting hemodynamic alterations may lead to diminution or complete regression of related aneurysms.15 In an effort to clarify some of these issues, we have reviewed our experience with a relatively large, unselected AVM patient population.
The authors thank Drs. M. C. Wallace and M. Tymianski for their contribution to the neurosurgical care of many of these patients and for their support of the Brain Vascular Malformation Study Group.
Perret GNishioka H: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section VI. Arteriovenous malformations. An analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported to the cooperative study. J Neurosurg 25:467–4901966J Neurosurg 25:
Willinsky RLasjaunias PTerbrugge Ket al: Brain arteriovenous malformations: analysis of the angio-architecture in relationship to hemorrhage (based on 152 patients explored and/or treated at the hospital de Bicêtre between 1981 and 1986). J Neuroradiol 15:225–2371988J Neuroradiol 15:
Dr. Redekop was supported by a Detweiler Traveling Fellowship from the Royal College of Physicians and Surgeons of Canada.