Intravascular Correction of Combined Arteriovenous Developmenatl Defects

Svistov D.V., Kandyba D.V., Voznesenskaya N.N., Savello A.V.

(Chair of Neurosurgery of the Medicomilitary Academy)

A combination of cerebral arteriovenous malformations (AVM) with aneurysms is a relatively rare form of arteriovenous developmental defects, watched in 2.7% (Paterson et al., 1956) - 23% (Lasjaunias et al., 1988) of cases. Aneurysms are a source of hemorrhages in 33% (Batjer et al., 1986) - 75% (Drake et al., 1986) of cases with this combination.

Aneurysms were watched in 6 (38%) out of 157 cases with verified AVM. A combination of "true" bifurcation aneurysm (basilar, superior cerebellar, internal carotid arteries) with large AVM of temporal (2 cases) and frontal lobes was observed in 3 patients. Aneurysms of feeding arteries in paranidal (2) or intranidal (1) segments were diagnosed in 3 cases. A hemorrhagic course of the disease was typical of 1/3 of patients. Balloon-occlusion of aneurysm with AVM delayed embolization, one-stage thrombosing of aneurysms by platinum mechanically detachable microspirals and AVM embolization were used in case of bifurcation aneurysms. Embolization of dysplastic aneurysms was achieved by Hystoacryl administration into a feeding vessel. It allowed to embolize a part of the AVM glome and to obliterate aneurysm completely. Presence of aneurysms of vessels, feeding AVM, puts forward necessity of discussing a problem of solid emboli use.