• Raper Daniel M S DMS Department of Neurological Surgery, University of California, San Francisco, California, USA., Ethan A Winkler, W Caleb Rutledge, Steven W Hetts, and Adib A Abla.
• Department of Neurological Surgery, University of California, San Francisco, California, USA.
• World Neurosurg. 2020 Jul 1; 139: e618-e625.

BackgroundAneurysms associated with brain arteriovenous malformations (AVMs) represent a hemorrhage risk in addition to that of the AVM nidus. In high-risk or unresectable cases, targeted treatment of an aneurysm causing hemorrhage may effectively decrease future hemorrhage risk. The objective of this report is to describe our series of patients with intraventricular AVM-associated aneurysms treated surgically. We highlight technical nuances of the surgical approaches to aneurysms in the lateral and third ventricles.MethodsA retrospective review was performed of patients in whom an intraventricular aneurysm rupture was responsible for hemorrhage. In each patient, the aneurysm was excluded surgically via an interhemispheric approach, including transcallosal, transchoroidal, or transcingulate corridors. Aneurysm, AVM characteristics, surgical approach, and outcomes were reviewed.ResultsSix patients were included in the series. In 5 patients, the disease was located on the left and approached from the right. Aneurysms were located in, or projecting into, the lateral ventricle in 4 patients (transcingulate approach) and in the third ventricle in 2 patients (transchoroidal fissure approach). The aneurysm was clipped in 1 patient and resected in 5 patients. The associated AVM was resected in 2 patients. In all patients, the surgical approach allowed adequate treatment of the aneurysm without new neurologic morbidity. No patients experienced recurrent intraventricular hemorrhage during follow-up.ConclusionsRuptured intraventricular aneurysms associated with brain AVMs can be treated surgically to reduce the risk of rebleeding in patients in whom the aneurysms are not accessible to endovascular treatment and in which the AVM nidus may not be safely resected.Copyright © 2020 Elsevier Inc. All rights reserved.

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