Decision Analysis for AVM-Associated Aneurysms

Intracranial AVMs (iAVMs) are associated with an increased incidence of intracranial aneurysms, and certain forms of iAVM-associated aneurysms increase the risk of hemorrhage, which is the main cause of morbidity and mortality related to iAVMs. Intranidal and flow-related prenidal aneurysms are independently associated with an increased risk of intracranial hemorrhage. Therefore these lesions are particularly important to identify and address. Optimal management of these aneurysms, however, is challenging and requires consideration of clinical presentation and iAVM curability. In this chapter, the authors briefly review the classification and natural history of iAVM-associated aneurysms, discuss key variables that underlie clinical decision-making, and present an algorithm for managing iAVM-associated aneurysms..