Gew Jessie, Sokol Drahoslav, Gallo Pasquale, Kandasamy Jothy, Keston Peter, Downer Jonny, Fouyas Ioannis, Kaliaperumal Chandrasekaran
NHS Lothian, Edinburgh, UK.
Childs Nerv Syst. 2019 Nov;35(11):2211-2218. doi: 10.1007/s00381-019-04328-4. Epub 2019 Aug 10.
Cerebral arteriovenous malformations (AVMs) are frequently associated with concurrent aneurysms. These aneurysms are commonly haemodynamically related to the AVM and can be classified into extranidal or intranidal in reference to the AVM nidus. An aneurysm arising from an artery that does not angiographically contribute to the blood flow to the AVM is uncommon. A distal middle cerebral artery (dMCA) aneurysm itself is also a rare presentation, especially in paediatric population. We present a rare case of dMCA aneurysm that was noted after successful surgical management of a ruptured AVM in an 8-year-old child and its management. BACKGROUND: About 10-30% of patients with cerebral arteriovenous malformation (AVM) have an associated artery aneurysm. The majority of these aneurysms are flow-related to the malformation. These aneurysms can be classified into extranidal or intranidal in reference to the AVM nidus Rammos et al Am J Neuroradiol 37:1966-1971, [1]. An aneurysm arising from a different artery that does not angiographically contribute to the blood flow associated with the AVM is less common and would generally be regarded as unrelated to the AVM. Distal cerebral artery aneurysm itself is also a rare presentation, comprising of 1-7% of all middle cerebral artery aneurysm. In children, mycotic infection and dissection are the two most common causes for aneurysm in this location. Unlike in adults, berry aneurysms are uncommon in children. We describe a young patient who was found to have distal middle cerebral artery (dMCA) aneurysm in follow-up DSA (Digital Subtraction Angiogram) after the initial successful surgical treatment for a cerebral frontal AVM. In this particular case, endovascular repair is thought to be the best strategy to treat the aneurysm. However, there still remains a lack of consensus of the best management strategy (surgery or endovascular) in treating flow-related aneurysms in general. This is usually based on an individual case scenario and the treatment is tailored depending on various factors including the expertise of the treating team.
脑动静脉畸形（AVM）常伴有并发动脉瘤。这些动脉瘤通常与AVM存在血流动力学关联，根据AVM瘤巢可分为巢外或巢内动脉瘤。起源于在血管造影上对AVM血流无贡献的动脉的动脉瘤并不常见。大脑中动脉远端（dMCA）动脉瘤本身也是一种罕见表现，尤其在儿童群体中。我们报告一例8岁儿童在成功手术治疗破裂AVM后发现的dMCA动脉瘤及其治疗情况。背景：约10% - 30%的脑动静脉畸形（AVM）患者伴有相关动脉动脉瘤。这些动脉瘤大多与畸形存在血流关联。根据AVM瘤巢，这些动脉瘤可分为巢外或巢内动脉瘤（Rammos等人，《美国神经放射学杂志》37:1966 - 1971，[1]）。起源于不同动脉且在血管造影上对与AVM相关的血流无贡献的动脉瘤较少见，通常被认为与AVM无关。大脑远端动脉动脉瘤本身也是一种罕见表现，占所有大脑中动脉动脉瘤的1% - 7%。在儿童中，霉菌性感染和夹层分离是该部位动脉瘤的两个最常见原因。与成人不同，儿童中浆果样动脉瘤并不常见。我们描述了一名年轻患者，在最初成功手术治疗额叶脑AVM后，在后续数字减影血管造影（DSA）检查中发现大脑中动脉远端（dMCA）动脉瘤。在这个特殊病例中，血管内修复被认为是治疗该动脉瘤的最佳策略。然而，对于一般情况下与血流相关动脉瘤的最佳治疗策略（手术或血管内治疗）仍缺乏共识。这通常基于个体病例情况，治疗会根据包括治疗团队专业知识在内的各种因素进行调整。
