title: Endovascular treatment of cerebral aneurysms associated with arteriovenous malformations.
abstract: OBJECTIVE
  In univariate survival analysis, coexisting aneurysms was associated with a significantly increased risk of hemorrhage in AVMs. We report here on our clinical experience with AVMs associated with arterial aneurysms that were managed by endovascular treatment.
  
  
  METHODS
  To determine the incidence of associated aneurysms, the authors reviewed 366 consecutive patients with AVMs managed between 1999 and 2009. In 86 (23.5%) of these 366 patients, 55 intranidal aneurysms and 40 proximal aneurysms were observed. Targeted endovascular treatment with coils, n-butylcyanoacrylate(NBCA) and Onyx was performed for patients in this series, using a standard protocol. We reviewed the treatment plans, radiological findings and clinical courses of 86 patients suffering AVM associated with aneurysm.
  
  
  RESULTS
  Ninety-five aneurysms in 86 patients with AVMs were enrolled in this study. Hemorrhage was the most frequent presenting symptom (69 patients, 80.2%). Bleeding was caused by an AVM nidus in 44 cases, aneurysm rupture in 20 and an undetermined origin in 5. Four patients were treated for associated aneurysm with coils followed by AVM embolization and 82 patients were treated with NBCA or Onyx embolization. There were total of 3 complications (3.5%) clinically significant complications in this series. Excellent or good outcomes (Glasgow Outcome Scale ≥ 4) were observed in 63 (73.3%) patients at discharge. Neurological deficits (Glasgow Outcome Scale 1-4) were 16.6% at discharge.
  
  
  CONCLUSIONS
  Endovascular treatment can be adequately used for cerebral aneurysms associated with AVMs as an adjunct to microsurgery and radiosurgery.
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
authors.forename: Xianli
authors.initials: X
authors.lastname: Lv
authors.forename: Zhongxue
authors.initials: Z
authors.lastname: Wu
authors.forename: Youxiang
authors.initials: Y
authors.lastname: Li
authors.forename: Xinjian
authors.initials: X
authors.lastname: Yang
authors.forename: Chuhan
authors.initials: C
authors.lastname: Jiang
authors.forename: Yong
authors.initials: Y
authors.lastname: Sun
authors.forename: Nai
authors.initials: N
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use; D004621:Embolization, Therapeutic; D004659:Enbucrilate / Q000627:therapeutic use; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: C450660:Onyx copolymer; D011145:Polyvinyls; D004659:Enbucrilate; D004121:Dimethyl Sulfoxide