• World Neurosurg · Oct 2021

    Conservatively managed flow aneurysms associated with brain AVMs.

    • Karol P Budohoski, Midhun Mohan, Zack Millar, Tamara Tajsic, Damiano G Barone, Jennifer J L Cao, Saniya Mediratta, Ellie Phelps, Tanmay Sukthankar, Ramez W Kirollos, Adel E Helmy, Mathew R Guilfoyle, and Rikin A Trivedi.
    • Department of Neurosurgery, Cambridge University Hospitals, University of Cambridge, Cambridge, United Kingdom. Electronic address: karol.budohoski@gmail.com.
    • World Neurosurg. 2021 Oct 1; 154: e754-e761.

    BackgroundFlow aneurysms (FAs) associated with brain arteriovenous malformations (AVMs) are thought to arise from increased hemodynamic stress due to high-flow shunting. This study aims to describe the changes in conservatively managed FAs after successful AVM treatment.MethodsPatients with symptomatic AVMs and associated FAs who underwent successful treatment of the AVM between 2008 and 2017 were included. FA dimensions were measured on surveillance angiography to assess longitudinal changes.ResultsThirty-two patients were identified with 48 FAs. Sixteen (33%) FAs were treated endovascularly; 18 (38%) FAs were treated surgically; and 14 (29%) FAs (11 patients) were monitored. FAs demonstrated a decrease in size from 5.0 mm to 3.8 mm (24%; P = 0.016) and 4.9 mm to 3.6 mm (27%; P = 0.013) in height and width, respectively, over a median 35 months. However, on subgroup analysis, only class IIb aneurysms demonstrated a significant decrease in size (51% reduction in largest diameter, P = 0.046) and only 3 FAs (21%) resolved. There were no hemorrhages observed during follow-up.ConclusionsWhile conservatively managed FAs demonstrated a reduction in size after the culprit AVM was treated, this was only significant in FAs located close to an AVM nidus (class IIb). There were no hemorrhages during the median 35 months' follow-up; however, long-term data are lacking. Our data support close observation of all conservatively managed aneurysms and a tailored approach based on the proximity to the nidus and observed changes in size.Copyright © 2021 Elsevier Inc. All rights reserved.

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