Giant splenic artery aneurysm associated with arteriovenous malformation

Giant splenic artery aneurysms are extremely rare entities that have important clinical implications. The size and the natural history pose unique challenges in the management of these lesions. We present one such case that was associated with a primary arteriovenous malformation in the splenic hilum. This is the third largest aneurysm reported in literature so far and the characteristic feature is that this is the first case of a hilar arteriovenous fistula complicated by formation of a giant aneurysm and another smaller aneurysm. In our opinion the hilar malformation was congenital in origin and responsible for the formation of the two aneurysms. We also present an up to date review of literature on this subject.     

Giant venous aneurysm associated with hypogastric arteriovenous malformation

Venous aneurysms are extremely rare. They may be congenital or acquired in origin and occasionally related to arteriovenous communications. A 58-year-old man complained of dull left lower quadrant pain and constipation. On physical examination a soft deep mass was palpated. Ultrasonogram and CT scan revealed a cystic formation in the pelvic cavity. Angiograms disclosed an arteriovenous malformation (AVM) at the pelvic floor draining into a large cavity. The patient was successfully managed by intraoperative selective embolization of the AVM and partial resection of a 10.6 x 8 x 6.7 cm venous aneurysm. The histopathologic studies of the wall confirmed a venous structure. Venous dilatation has been reported in high flow vein grafts, blood access V fistulas and rarely, proximal to traumatic AV fistulas of the lower extremities. The etiology of the present case is probably congenital, being to the best of our knowledge, the first case affecting the hypogastric territory, reported in the English literature.     

Spinal cord arteriovenous malformation with an associated lymphatic anomaly. Case report

Spinal cord arteriovenous malformations (AVM's), like other vascular anomalies of the central nervous system, can be associated with similar vascular lesions of the skin and viscera. A 7-year-old girl, who presented with rapidly progressing paraplegia, was found to have a spinal cord AVM, cutaneous angioma, and a chylous malformation of the lymphatic system. She had previously undergone treatment for a posterior thoracic cutaneous angioma. At surgery, upon incision of the paravertebral muscle fascia, viscous pale fluid was encountered emanating from a foramen in the thoracic lamina. The spinal AVM was resected in spite of concern that the abnormality represented spinal osteomyelitis. Postoperatively, there was full return of function in the lower extremities, along with recurrent episodes of chylothorax, which slowly came under control with dietary manipulation. A review of the anatomy of the thoracic duct and nontraumatic causes of chylothorax is presented, and the association of cutaneous and central angiomas is discussed. Finally, the treatment of chylothorax is delineated.     

Congenital multiple cavernous angiomas associated with thrombosed arteriovenous malformation of the brain--case report

A 16-year-old girl presented with multiple cerebral cavernous angiomas with calcifications due to repeated hemorrhages and a thrombosed cerebral arteriovenous malformation (AVM). Her 18-year-old elder sister also had multiple cerebral cavernous angiomas associated with calcifications, which suggested presence of repeated previous hemorrhages. Surgical removal via a right occipital craniotomy resulted in a good outcome. The histological diagnosis was thrombosed AVM. Evaluation of congenital vascular anomaly needs to take into consideration the combination of other congenital vascular anomalies and their familial occurrence.     

Giant thrombosed vertebral artery aneurysm managed with extracranial-intracranial bypass surgery and aneurysmectomy. Case report.

A case is presented of a left giant thrombosed vertebral artery aneurysm in a 46-year-old man. The giant thrombosed aneurysm was successfully resected with trapping of the affected artery after right external carotid artery-posterior cerebral artery bypass surgery using a radial arterial graft. The clinical course is reported, and the details of the operative approach and techniques are discussed.     

Rapid development of an intranidal aneurysm with perifocal brain edema in an unruptured cerebral arteriovenous malformation. Case report

The authors present the case of a 22-year-old man with an unruptured arteriovenous malformation (AVM) in which an intranidal aneurysm had grown in the course of 3 months and was complicated by perifocal brain edema. A left parietal AVM was incidentally diagnosed on magnetic resonance (MR) imaging. No aneurysms were noted on cerebral angiograms obtained simultaneously. Three months later, T2-weighted MR imaging revealed perifocal brain edema (increased signal intensity in the brain parenchyma adjacent to the nidus). An aneurysm-like signal void was demonstrated in the center of the high-signal area, but no previous hemorrhages could be detected. Angiographic studies revealed an intranidal aneurysm 4 mm in diameter projecting anterolaterally from the nidus. Surgical removal was performed without incident, and no neurological deficits or postoperative complications were observed. An MR image obtained 2 weeks postsurgery revealed complete resolution of the perifocal brain edema. To the authors' knowledge, this is the first reported case of an unruptured AVM in which an intranidal aneurysm with perifocal brain edema developed rapidly (within a few months).     

Hemorrhage from moyamoya-like vessels associated with a cerebral arteriovenous malformation. Case report

The authors describe a case of subarachnoid hemorrhage from moyamoya-like vessels associated with an arteriovenous malformation (AVM) in a 44-year-old Hispanic man who presented with severe headache. The AVM was located in the left parietal lobe and the ipsilateral middle cerebral artery was occluded. Although the patient was initially neurologically intact, he began to experience neurological deficits from mild vasospasm, illustrating the sensitivity of the underperfused portion of brain surrounding an AVM. His neurological deficits improved with aggressive hydration and elevated blood pressure. After a 3-week period, the AVM was resected without complication and all of the patient's neurological deficits resolved. The authors review radiographic findings of this unique case.     

Extensive dural arteriovenous malformation. Case report

A child with an extensive dural arteriovenous malformation (AVM) of the sigmoid sinus and bilateral occlusion of the transverse sinus is reported. His intracranial venous flow had become rerouted through the right cavernous sinus and then into the right ophthalmic veins. The AVM was associated with severe hydrocephalus and a progressive devastating neurological deficit. The hemodynamic and intracranial pressure changes as well as the mechanism of sinus thrombosis are discussed. The role of aggressive surgical treatment is emphasized.     

Dural arteriovenous malformation in the posterior fossa associated with intracerebellar hematoma. Case report

A case of an infratentorial dural arteriovenous malformation associated with an intracerebellar hematoma is reported. This malformation was fed by meningeal branches of the right vertebral artery and was drained exclusively by pial veins in the posterior fossa.     

Giant arteriovenous malformation associated with unilateral moyamoya disease in a child: case report

BACKGROUND: Cerebral AVMs associated with definite or probable moyamoya disease is a very rare situation, and the association between them is unclear. CASE DESCRIPTION: An 8-year-old boy presented with repeated transient motor weakness in the left arm and leg for 1 year. On his admission, physical examination and neuropsychological testing showed no exact neurological deficits. Magnetic resonance imaging showed a giant AVM in the right basal ganglia and thalamus. Angiography revealed occlusion of left ICA and bilateral PCA with well-developed basal collateral vessels. A giant AVM was also noticed in angiography, which was filled by basal collateral vessels from both left anterior circulation and posterior circulation. The diagnosis of unilateral moyamoya disease combined with a Spetzler-Martin grade V AVM was made. The patient was managed nonoperatively and discharged with close follow-up. CONCLUSION: We present a rare case of giant AVM-associated with unilateral moyamoya disease, and giant AVM makes planning any aggressive treatments difficult.     

Giant aneurysm arising from a single arteriovenous fistula in a child. Case report

A case is presented of a child with an arteriovenous fistula and a giant aneurysm located beside the brain stem under the right temporal lobe. It was successfully treated by clipping its feeding artery, a branch of the right posterior cerebral artery. The similarities to, and the differences from, aneurysms of the vein of Galen are discussed.     

Enlargement of an arteriovenous malformation documented by angiography. Case report.

The authors present a case in which an enlarging arteriovenous malformation was documented angiographically. Enlargement of the malformation concurrent with the appearence of basilar artery insufficiency was ascribed to a sump effect (steal) by the arteriovenous shunt.     

Distal anterior choroidal artery aneurysm associated with an arteriovenous malformation. Intraoperative localization and treatment

BACKGROUND

Distal anterior choroidal artery aneurysms are rare. The outcome of patients with distal anterior choroidal artery aneurysms has been poor, and the treatment of such aneurysms is surgically challenging.

CASE DESCRIPTION

The authors describe the case of an 8-year-old girl with a ruptured distal anterior choroidal artery aneurysm associated with an arteriovenous malformation (AVM). The patient experienced sudden onset of headache and vomiting. Computed tomography revealed an intraventricular haemorrhage, and cerebral angiography demonstrated an aneurysm arising from the distal portion of the right anterior choroidal artery. The patient also had an AVM in the ipsilateral temporal lobe fed by the branches of the middle cerebral artery. A right frontotemporal craniotomy was performed with the aid of intraoperative angiography to eliminate both the AVM and the aneurysm. Intraoperative angiography was helpful in confirming the complete removal of the AVM and in accurate localization of the small and deeply placed distal anterior choroidal artery aneurysm. Both the AVM and the aneurysm were successfully treated and the patient was discharged without any neurological deficits.

CONCLUSION

This case is the youngest reported patient with a distal anterior choroidal artery aneurysm. This report is also the first to describe an association of such an aneurysm with an AVM. The etiology of the aneurysm formation in this case and surgical strategy for deeply placed vascular lesions are discussed.