脳動静脈奇形の治療における血管内治療の意義 : 付随動脈瘤の処置について  [in Japanese] The Significance of Endovascular Treatment for Aneurysms Associated with Arteriovenous Malformations  [in Japanese]

We reviewed 84 AVMs embolized over 7 years and studied the significance of the embolization for associated aneurysms. Out of 84 AVMs, 14 were preoperatively embolized and 66 were followed by radiosurgery. Ten intranidal aneurysms were found in 9 cases, all of which ruptured. Although 8 aneurysms were completely embolized, using glue, 2 incompletely treated aneurysms rebled. Out of 6 proximal feeder aneurysms, 3 ruptured ones were treated with detachable coils and have shown no rebleeding. The other 3 aneurysms that increased in size during the follow-up after the embolization of AVM were embolized without complications. Two flow-related aneurysms remained, and an AVM nidus was primarily treated. Both aneurysms disappeared after the embolization of AVM. The ruptured proximal feeder aneurysms located far from the nidus, which require another approach for the removal of AVM, should be embolized with coils to reduce surgical invasiveness. Embolization of intranidal aneurysms is very useful for the prevention of rebleeding, particularly in cases followed by radiosurgery. Among the flow-related aneurysm treatments, AVM may be the treatment of choice. As for the treatment strategy of AVM, it is important to detect and identify the associated aneurysms and treat them appropriately.