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De novo distal middle cerebral artery aneurysm post-excision of intracerebral arteriovenous malformation in an 8-year old

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Abstract

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.

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References

  1. Rammos SK, Gardenghi B, Bortolotti C, Cloft HJ, Lanzino G (2016) Aneuryms associated with brain arteriovenous malformations. Am J Neuroradiol 37(11):1966–1971. https://doi.org/10.3174/ajnr.A4869

    Article  CAS  PubMed  Google Scholar 

  2. Horiuchi T, Tanaka Y, Takasawa H, Murata T, Yako T, Hongo K (2004) Ruptured distal middle cerebral artery aneurysm. J Neurosurg 100:384–388

    Article  Google Scholar 

  3. Lv N, Zhou Y, Yang P, Li Q, Zhao R, Fang Y, Xu Y, Hong B, Zhao W, Liu J, Huang Q (2016) Endovascular treatment of distal middle cerebral artery aneurysms: report of eight cases and literature review. Interv Neuroradiol 22(1):12–17. https://doi.org/10.1177/1591019915617317

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chen R, Zhang S, Guo R, Ma L, You C (2018) Pediatric intracranial distal arterial aneurysms: report of 35 cases. Acta Neurochir 160:1633–1642. https://doi.org/10.1007/s00701-018-3574-0

    Article  PubMed  Google Scholar 

  5. Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ (1981) Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–169

    Article  CAS  Google Scholar 

  6. Kim EJ, Halim AX, Dowd CF, Lawton MT, Singh V, Bennett J, Young WL, UCSF BAVM Study Project (2004) The relationship of coexisting extranidal aneurysms to intracranial hemorrhage in patients harboring brain arteriovenous malformations. Neurosurgery 54:1349–1357; discussion 1357–58. https://doi.org/10.1227/01.NEU.0000124483.73001.12

    Article  PubMed  Google Scholar 

  7. Yılmaz M, Yurt A, Kalemci O, Yuksel ZK, Yücesoy K (2013) Ruptured distal middle cerebral artery aneurysm: case report. Int J Surg Case Rep 4(10):837–838. https://doi.org/10.1016/j.ijscr.2013.06.015

    Article  PubMed  PubMed Central  Google Scholar 

  8. vMcCarthy C, Kaliaperumal C, O’Sullivan M (2012) Recurrence of a paediatric arteriovenous malformation 9 years postcomplete excision: case report and review of literature. BMJ Case Rep 2012:bcr2012006826. Published 2012 Sep 25. https://doi.org/10.1136/bcr-2012-006826

    Article  Google Scholar 

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Authors and Affiliations

  1. NHS Lothian, Edinburgh, UK

    Jessie Gew, Drahoslav Sokol, Pasquale Gallo, Jothy Kandasamy, Peter Keston, Jonny Downer, Ioannis Fouyas & Chandrasekaran Kaliaperumal

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  1. Jessie Gew
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  2. Drahoslav Sokol
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  3. Pasquale Gallo
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  4. Jothy Kandasamy
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  5. Peter Keston
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  6. Jonny Downer
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  7. Ioannis Fouyas
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  8. Chandrasekaran Kaliaperumal
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Correspondence to Jessie Gew.

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Gew, J., Sokol, D., Gallo, P. et al. De novo distal middle cerebral artery aneurysm post-excision of intracerebral arteriovenous malformation in an 8-year old. Childs Nerv Syst 35, 2211–2218 (2019). https://doi.org/10.1007/s00381-019-04328-4

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  • DOI: https://doi.org/10.1007/s00381-019-04328-4

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