neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2017-0-1-66-71neurosurgery-419Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEГЕМОДИНАМИЧЕСКИЕ АНЕВРИЗМЫ ПРИ АВМ ГОЛОВНОГО МОЗГА: ОПИСАНИЕ ДВУХ КЛИНИЧЕСКИХ НАБЛЮДЕНИЙ И ОБЗОР ЛИТЕРАТУРЫHemodynamic associated aneurysms in patients with cerebral AVMs: two clinical cases and literature reviewЭлиаваШалва ШалвовичEliavaSh. Sh.noemail@neicon.ruДмитриевАлексей ВячеславовичDmitrievA. V.admitrijev@nsi.ruШехтманОлег ДмитриевичShekhtmanO. D.noemail@neicon.ruФГБУ НИИ нейрохирургии им. акад. Н.Н. БурденкоRussian Federation201724112017016671Copyright © Элиава Ш.Ш., Дмитриев А.В., Шехтман О.Д., 20172017Элиава Ш.Ш., Дмитриев А.В., Шехтман О.Д.Eliava S.S., Dmitriev A.V., Shekhtman O.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/419

Цель: Представить современный взгляд на проблему артериовенозных мальформаций (АВМ) головного мозга в сочетании с гемодинамическими аневризмами (ГА). Материалы и методы: в статье описываются 2 клинических наблюдения сочетания АВМ и ГА, в которых произошло кровоизлияние из аневризм после успешного иссечения АВМ-источника первичного кровоизлияния. Результаты: В работе подробно проанализированы клинические примеры и тактика их лечения, а также проведен литературный обзор проблемы. Несмотря на общепринятый подход лечения в первую очередь источника кровоизлияния, наши наблюдения указывают, что подобная тактика не всегда оправдана. Заключение: Случаи сочетания АВМ и ГА требуют тщательного обследования и подготовки к операции. ГА должны выключать одномоментно с иссечением АВМ или в первую очередь, независимо от источника первичного кровоизлияния.

Objective: to present the current strategies for treatment of cerebral arteriovenous malformations (AVMs) with associated aneurysms (AA). Materials and methods: this article describes two patients with AVM and AA. These patients underwent successful treatment of AVM (microsurgical excision) as a primary source of intracranial hemorrhage but suffered from aneurysm rupture in postoperative period. Results: This article presents the detailed review of clinical cases and treatment strategy in both patients as well as the literature review dedicated to this problem. Despite the conventional thinking about primary surgery of the intracranial hemorrhage source, authors’ experience indicates that this strategy is not always justified. Conclusion: The accurate diagnostics as well as careful preparation for surgery is obligatory for patients suffered from AVM with hemodynamic AA require careful diagnostics and operation prepare. Hemodynamic AA should be treated simultaneously with AVM resection or as the first stage of surgical treatment regardless of source of primary hemorrhage.

гемодинамические аневризмыартериовенозные мальформациихирургическое лечение АВМhemodynamic associated aneurysmsarteriovenous malformations (AVMs)surgical treatment of AVMReferencesTalanov A.B. Printsipy khirurgicheskogo lecheniya sochetannykh arteriovenoznykh mal’formatsii i anevrizm golovnogo mozga (Principles of surgical treatment associated cerebral arteriovenous malformations and aneurisms): dis.. kand. med. nauk: 14.00.28, Moscow, 1998, 128 p. (in Rus.) (Таланов А.Б. Принципы хирургического лечения сочетанных артериовенозных мальформаций и аневризм головного мозга: дис.. канд. мед. наук: 14.00.28. - М., 1998. - 128 с.)Talanov A.B. Printsipy khirurgicheskogo lecheniya sochetannykh arteriovenoznykh mal’formatsii i anevrizm golovnogo mozga (Principles of surgical treatment associated cerebral arteriovenous malformations and aneurisms): dis.. kand. med. nauk: 14.00.28, Moscow, 1998, 128 p. (in Rus.) (Таланов А.Б. Принципы хирургического лечения сочетанных артериовенозных мальформаций и аневризм головного мозга: дис.. канд. мед. наук: 14.00.28. - М., 1998. - 128 с.)Al-Jehani H., Tampieri D., Cortes M., Melarnon D. et al. Re-growth of a posterior inferior cerebellar artery aneurysm after resection of the associated posterior fossa arteriovenous malformation // Interv Neuroradiol. - 2014. - № 20. - P. 61-66.Al-Jehani H., Tampieri D., Cortes M., Melarnon D. et al. Re-growth of a posterior inferior cerebellar artery aneurysm after resection of the associated posterior fossa arteriovenous malformation // Interv Neuroradiol. - 2014. - № 20. - P. 61-66.Batjer H., Suss R.A., Samson D. Intracranial arteriovenous malformations associated with aneurysms // Neurosurgery. - 1986. - № 18. - P. 29-35.Batjer H., Suss R.A., Samson D. Intracranial arteriovenous malformations associated with aneurysms // Neurosurgery. - 1986. - № 18. - P. 29-35.Brock S., Giombini S., Ciceri E. Development and rupture of a de novo basilar artery aneurysm after surgical removal of a cerebellar arteriovenous malformation // Acta Neurochir (Wien). - 2003. - № 145. - P. 1117-1120.Brock S., Giombini S., Ciceri E. Development and rupture of a de novo basilar artery aneurysm after surgical removal of a cerebellar arteriovenous malformation // Acta Neurochir (Wien). - 2003. - № 145. - P. 1117-1120.Brown R.D. Jr, Wiebers D.O., Forbes G.S. Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions // J Neurosurg. - 1990. - № 73. - P. 859-863.Brown R.D. Jr, Wiebers D.O., Forbes G.S. Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions // J Neurosurg. - 1990. - № 73. - P. 859-863.Cunha e Sa M.J., Stein B.M., Solomon R.A,. McCormick P.C. The treatment of associated intracranial aneurysms and arteriovenous malformations // J Neurosurg. - 1992. - № 77. - P. 853-859.Cunha e Sa M.J., Stein B.M., Solomon R.A,. McCormick P.C. The treatment of associated intracranial aneurysms and arteriovenous malformations // J Neurosurg. - 1992. - № 77. - P. 853-859.Folkow B., Gurnvich M., Hall^ck M., et al. The hemodynamic consequences of regional hypotension in spontaneously hypertensive and normotensive rats // Acta Physiol Scand. - 1971. - № 83. - P. 532-541.Folkow B., Gurnvich M., Hall^ck M., et al. The hemodynamic consequences of regional hypotension in spontaneously hypertensive and normotensive rats // Acta Physiol Scand. - 1971. - № 83. - P. 532-541.Flores B.C., Klinger D.R., Rickert K.L. et al. Management of intracranial aneurysms associated with arteriovenous malformations // Neurosurg Focus. - 2014. - № 37. - P. 1-14.Flores B.C., Klinger D.R., Rickert K.L. et al. Management of intracranial aneurysms associated with arteriovenous malformations // Neurosurg Focus. - 2014. - № 37. - P. 1-14.Gao E., Young W.L., Pile-Spellman J. et al. Cerebral arteriovenous malformation feeding artery aneurysms: a theoretical model of intravascular pressure changes after treatment // Neurosurgery. - 1997. - № 41. - P. 13451356.Gao E., Young W.L., Pile-Spellman J. et al. Cerebral arteriovenous malformation feeding artery aneurysms: a theoretical model of intravascular pressure changes after treatment // Neurosurgery. - 1997. - № 41. - P. 13451356.Hayashi S., Arimoto T., Itakura T., et al. Fujii T., Nishiguchi T., Komai N. The association of intracranial aneurysms and arteriovenous malformation of the brain. Case report // J Neurosurg. - 1981. - № 55. - P. 971-975.Hayashi S., Arimoto T., Itakura T., et al. Fujii T., Nishiguchi T., Komai N. The association of intracranial aneurysms and arteriovenous malformation of the brain. Case report // J Neurosurg. - 1981. - № 55. - P. 971-975.Hernesniemi J.A., Dashti R., Juvela S. et al. Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients // Neurosurgery. - 2008. - № 63. - P. 823-831.Hernesniemi J.A., Dashti R., Juvela S. et al. Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients // Neurosurgery. - 2008. - № 63. - P. 823-831.Joint Writing Group of the Technology Assessment Committee American Society of Interventional and Therapeutic Neuroradiology; Joint Section on Cerebrovascular Neurosurgery a Section of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; Section of Stroke and the Section of Interventional Neurology of the American Academy of Neurology, Atkinson R.P., Awad I.A., Batjer H.H., Dowd C.F., Furlan A., Giannotta S.L., Gomez C.R., Gress D., Hademenos G., Halbach V., Hemphill J.C., Higashida R.T., Hopkins L.N., Horowitz M.B., Johnston S.C., Lawton M.W., McDermott M.W., Malek A.M., Mohr J.P., Qureshi A.I., Riina H., Smith W.S., Pile-Spellman J., Spetzler R.F., Tomsick T.A., Young W.L. Reporting terminology for brain arteriovenous malformation clinical and radiographic features for use in clinical trials // Stroke. - 2001. - № 32. - P. 1430-1442.Joint Writing Group of the Technology Assessment Committee American Society of Interventional and Therapeutic Neuroradiology; Joint Section on Cerebrovascular Neurosurgery a Section of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; Section of Stroke and the Section of Interventional Neurology of the American Academy of Neurology, Atkinson R.P., Awad I.A., Batjer H.H., Dowd C.F., Furlan A., Giannotta S.L., Gomez C.R., Gress D., Hademenos G., Halbach V., Hemphill J.C., Higashida R.T., Hopkins L.N., Horowitz M.B., Johnston S.C., Lawton M.W., McDermott M.W., Malek A.M., Mohr J.P., Qureshi A.I., Riina H., Smith W.S., Pile-Spellman J., Spetzler R.F., Tomsick T.A., Young W.L. Reporting terminology for brain arteriovenous malformation clinical and radiographic features for use in clinical trials // Stroke. - 2001. - № 32. - P. 1430-1442.Kim E.J., Halim A.X., Dowd C.F., et al. The relationship of coexisting extranidal aneurysms to intracranial hemorrhage in patients harboring brain arteriovenous malformations // Neurosurgery. - 2004. - № 54. - P. 1349-1357.Kim E.J., Halim A.X., Dowd C.F., et al. The relationship of coexisting extranidal aneurysms to intracranial hemorrhage in patients harboring brain arteriovenous malformations // Neurosurgery. - 2004. - № 54. - P. 1349-1357.Lasjaunias P., Piske R., Terbrugge K., Willinsky R. Cerebral arteriovenous malformations (C. AVM) and associated arterial aneurysms (AA). Analysis of 101 C. AVM cases, with 37 AA in 23 patients // Acta Neurochir (Wien). - 1988. - № 91. - P. 29-36.Lasjaunias P., Piske R., Terbrugge K., Willinsky R. Cerebral arteriovenous malformations (C. AVM) and associated arterial aneurysms (AA). Analysis of 101 C. AVM cases, with 37 AA in 23 patients // Acta Neurochir (Wien). - 1988. - № 91. - P. 29-36.Lv X., Wu Z., Li Y., et al. Cerebral arteriovenous malformations associated with flow-related and circle of Willis aneurysms // World Neurosurg. - 2011. - № 76. - P. 455-458.Lv X., Wu Z., Li Y., et al. Cerebral arteriovenous malformations associated with flow-related and circle of Willis aneurysms // World Neurosurg. - 2011. - № 76. - P. 455-458.Meisel H.J., Mansmann U., Alvarez H., et al. Cerebral arteriovenous malformations and associated aneurysms: analysis of 305 cases from a series of 662 patients // Neurosurgery. - 2000. - № 46. - P. 793-800.Meisel H.J., Mansmann U., Alvarez H., et al. Cerebral arteriovenous malformations and associated aneurysms: analysis of 305 cases from a series of 662 patients // Neurosurgery. - 2000. - № 46. - P. 793-800.Perata H.J., Tomsick T.A., Tew J.M. Jr. Feeding artery pedicle aneurysms: association with parenchymal hemorrhage and arteriovenous malformation in the brain // J Neurosurg. - 1994. - № 80. - P. 631-634.Perata H.J., Tomsick T.A., Tew J.M. Jr. Feeding artery pedicle aneurysms: association with parenchymal hemorrhage and arteriovenous malformation in the brain // J Neurosurg. - 1994. - № 80. - P. 631-634.Piotin M., Ross I.B., Weill A., et al. Intracranial arterial aneurysms associated with arteriovenous malformations: endovascular treatment // Radiology. - 2001. - № 220. - P. 506-513.Piotin M., Ross I.B., Weill A., et al. Intracranial arterial aneurysms associated with arteriovenous malformations: endovascular treatment // Radiology. - 2001. - № 220. - P. 506-513.Platz J., Berkefeld J., Singer O.C., et al. Frequency, risk of hemorrhage and treatment considerations for cerebral arteriovenous malformations with associated aneurysms // Acta Neurochir (Wien). - 2014. - № 156. - P. 2025-2034.Platz J., Berkefeld J., Singer O.C., et al. Frequency, risk of hemorrhage and treatment considerations for cerebral arteriovenous malformations with associated aneurysms // Acta Neurochir (Wien). - 2014. - № 156. - P. 2025-2034.Pollock B.E., Flickinger J.C., Lunsford L.D., et al. Hemorrhage risk after stereotactic radiosurgery of cerebral arteriovenous malformations // Neurosurgery. - 1996. - № 38. - P. 652-659.Pollock B.E., Flickinger J.C., Lunsford L.D., et al. Hemorrhage risk after stereotactic radiosurgery of cerebral arteriovenous malformations // Neurosurgery. - 1996. - № 38. - P. 652-659.Redekop G., TerBrugge K., Montanera W., Willinsky R. Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage // J Neurosurg. - 1998. - № 89. - P. 539546.Redekop G., TerBrugge K., Montanera W., Willinsky R. Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage // J Neurosurg. - 1998. - № 89. - P. 539546.Shenkin H.A., Jenkins F., Kim K. Arteriovenous anomaly of the brain associated with cerebral aneurysm. Case report // J Neurosurg. - 1971. - № 34. - P. 225-228.Shenkin H.A., Jenkins F., Kim K. Arteriovenous anomaly of the brain associated with cerebral aneurysm. Case report // J Neurosurg. - 1971. - № 34. - P. 225-228.Stapf C., Mohr J.P., Pile-Spellman J., et al. Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation // J Neurol Neurosurg Psychiatry. - 2002. - № 73. - P. 294-8.Stapf C., Mohr J.P., Pile-Spellman J., et al. Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation // J Neurol Neurosurg Psychiatry. - 2002. - № 73. - P. 294-8.Stein K.P., Wanke I., Forsting M., et al. Associated aneurysms in supratentorial arteriovenous malformations: impact of aneurysm size on haemorrhage // Cerebrovasc Dis. - 2015. - № 39. - P. 122-129.Stein K.P., Wanke I., Forsting M., et al. Associated aneurysms in supratentorial arteriovenous malformations: impact of aneurysm size on haemorrhage // Cerebrovasc Dis. - 2015. - № 39. - P. 122-129.Thompson R.C., Steinberg G.K., Levy R.P., Marks M.P. The management of patients with arteriovenous malformations and associated intracranial aneurysms // Neurosurgery. - 1998. - № 43. - P. 202-212.Thompson R.C., Steinberg G.K., Levy R.P., Marks M.P. The management of patients with arteriovenous malformations and associated intracranial aneurysms // Neurosurgery. - 1998. - № 43. - P. 202-212.Turjman F., Massoud T.чF., Vicuela F., et al. Aneurysms related to cerebral arteriovenous malformations: superselective angiographic assessment in 58 patients // AJNR Am J Neuroradiol. - 1994. - № 15. - P. 1601-1605.Turjman F., Massoud T.чF., Vicuela F., et al. Aneurysms related to cerebral arteriovenous malformations: superselective angiographic assessment in 58 patients // AJNR Am J Neuroradiol. - 1994. - № 15. - P. 1601-1605.

The authors declare that there are no conflicts of interest present.