Neurointervention.  2011 Feb;6(1):27-30. 10.5469/neuroint.2011.6.1.27.

Multiple Feeding Artery Pedicle Pseudoaneurysms in the Posterior Circulation: Association with Hemorrhage and AVM

• Lim SM
• Cho YJ
• Lee R

• KMID: 1783979
• DOI: http://doi.org/10.5469/neuroint.2011.6.1.27

Abstract

We experienced rare combination of multiple irregular shaped aneurysms along the course of the feeding artery and arteriovenous malformation (AVM) in the posterior circulation. We could not explain which aneurysm was a cause of bleeding because all the aneurysms showed irregular in shape like pseudoaneurysms and location of the aneurysms was very close each other. We report two cases in which multiple irregular shaped aneurysms were related with AVMs and first episode of hemorrhage.

Keyword

Aneurysm; Arteriovenous malformation; Embolization

MeSH Terms

Aneurysm
Aneurysm, False
Arteries
Arteriovenous Malformations
Hemorrhage

Figure

• 

  Fig. 1 Case 1A. Anteroposterior view of right vertebral artery angiogram shows two aneurysms (long arrow) at left pontine artery, two aneurysms (short arrow) in premeatal and meatal segment of left anterior inferior cerebellar artery (AICA) with associated AVM distal from the aneurysms.B. Two aneurysms and part of AVM feeders of left AICA and left pontine artery are embolized with n-butylcyanoacrylate (NBCA) mixture.C. Follow up angiogram after NBCA embolization and stereotactic radiosurgery shows a small residual draining vein without definite visible AVM nidus.

• 

  Fig. 2 Case 2A. Anteroposterior view of left vertebral artery angiogram shows two aneurysms (arrow) at the feeding pedicle of anterior inferior cerebellar artery (AICA) and peripheral AVM fed by the AICA and superior cerebellar artery.B. Road map image shows NBCA cast at aneurysms of right AICA and feeder of AVM.C. 1 year follow up angiogram after NBCA embolization and stereotactic radiosurgery shows residual small AVM nidus and draining vein in right cerebellar region.

Reference

1. Lasjaunias P, Piske R, Terbrugge K, Willinsky R. Cerebral arteriovenous malformations (C. AVM) and associated arterial aneurysms (AA). Analysis of 101 C. AVM cases, with 37 AA in 23 patients. Acta Neurochir (Wien). 1988; 91:29–36. PMID: 3293363.

2. Cockroft KM, Thompson RC, Steinberg GK. Aneurysms and arteriovenous malformations. Neurosurg Clin N Am. 1998; 9:565–576. PMID: 9668188.

3. Thompson RC, Steinberg GK, Levy RP, Marks MP. The management of patients with arteriovenous malformations and associated intracranial aneurysm. Neurosurgery. 1998; 43:202–211. PMID: 9696071.

4. Marks MP, Lane B, Steinberg GK, Chang PJ. Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants. Radiology. 1990; 176:807–813. PMID: 2389040.

5. Khayata MH, Zabramski JM, Johnson PC, Flom R. False aneurysm associated with rupture of an arteriovenous malformation-implication for treatment: case report. Neurosurgery. 1993; 33:753–756. PMID: 8053999.

6. Marks MP, Lane B, Steinberg GK, Snipes GJ. Intranidal aneurysms in cerebral arteriovenous malformations: evaluation and endovascular treatment. Radiology. 1992; 183:355–360. PMID: 1561335.

7. Perata HJ, Tomsick TA, Tew JM Jr. Feeding artery pedicle aneurysms: association with parenchymal hemorrhage and arteriovenous malformation in the brain. J Neurosurg. 1994; 80:631–634. PMID: 8151340.

8. Blackford JM, Mclaughlim JS. Pseudoaneurysms of the carotid artery. Am Surg. 1973; 39:257–260. PMID: 4700655.

9. Nayeem SA, Tada Y, Takagi A, Sato O, Miyata T, Idezuki Y. Carotid artery pseudoaneurysm following internal jugular vein cannulation. J Cardiovasc Surg (Torino). 1990; 31:182–183.

10. Andaluz N, Pensak ML, Zuccarello M. Multiple, peripheral aneurysms of the anterior inferior cerebellar artery. Acta Neurochir (Wien). 2005; 147:419–422. PMID: 15625587.