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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2022; 11(03): 265-268
DOI: 10.1055/s-0040-1718239
Case Report

Case Series for Gamma Knife Surgery for Arteriovenous Malformation Associated Intracranial Aneurysms

Jungwook Baek 
1   Department of Neurological Surgery, Inje University Busan Paik Hospital, Busan, South Korea
,
Mooseong Kim
1   Department of Neurological Surgery, Inje University Busan Paik Hospital, Busan, South Korea
,
Seyoung Pyo
1   Department of Neurological Surgery, Inje University Busan Paik Hospital, Busan, South Korea
,
Youngjin Heo
2   Department of Diagnostic Radiology, Inje University Busan Paik Hospital, Busan, South Korea
,
Seong Ho Kim
3   Department of Neurological Surgery, DaeKoo, Korea
,
Cheol Ahn
4   Department of Neurological Surgery, ChoonHae Hospital, Busan, Korea
,
Jeongeun Kim
5   Boston University College of Arts and Sciences: Biology, Boston, Massachusetts, United States
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Abstract

Objective The incidence of aneurysms coexisting with arteriovenous malformations (AVMs) ranges between 2.7% and 16.7%. The anatomical relationship between AVM and aneurysm is critical in deciding the best management.

Methods Between October 1994 and August 2017, gamma knife surgery (GKS) was performed in six patients with AVMs and associated aneurysms. The patients consisted of four men and two women with a mean age of 37.8 years (range, 18−57 years). The mean follow-up was 34.2 months (range, 13−84 months). The mean maximal dose was 35.9 Gy and the mean margin dose to AVM was 18 Gy. Coil embolization was performed in one of the aneurysms prior to GKS. In our study, GKS was performed in six AVM-associated aneurysms. Of the six aneurysms, four were intranidal and two were pedicular. The mean volume of AVMs was 3.6 cm3 (range, 1.6−6.5 cm3).

Results The locations of aneurysms are as follows: four on posterior cerebral artery (PCA), one on posterior inferior cerebellar artery (PICA), and one on middle cerebral artery (MCA). Sublocation sites were MCA M3 above, PCA P3 above, and PICA distal. There were no GKS-related complications. Complete obliteration of AVM and aneurysm was documented in all four patients with intranidal aneurysm-associated AVMs. Both the aneurysm and AVM were completely obliterated in the two patients with proximal pedicular aneurysms.

Conclusion GKS is a possible treatment for AVM with associated intranidal or pedicular aneurysms located above P3 or M3, etc., in which there is less turbulent flow and jet flow.

Keywords

aneurysm - arteriovenous malformation - gamma knife


Publication History

Article published online:
31 March 2022

© 2022. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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