Cerebral Arteriovenous Aneurysms

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Abstract
Until recent years the diagnosis, localization and treatment of cerebral arteriovenous aneurysms presented almost insurmountable difficulties. The frequency of these lesions compared with series of verified brain tumors was found to be about 2%. Available evidence indicated that such malformations occur twice as often in males as in females. The most common symptoms and signs in order of frequency were found to be: seizures (usually Jacksonian or focal), spontaneous subarachnoid hemorrhage, intracerebral hemorrhage, psychic and mental disturbances, and headache (often migrainous in type). The diagnosis on clinical evidence alone is often impossible, but can be made on the basis of: (1) a history of focal or Jacksonian seizures; (2) spontaneous subarachnoid hemorrhage; (3) the presence of a bruit; and (4) roentgen evidence of floccular intracranial calcification. Cerebral angiography offers the best method of establishing the presence of an arteriovenous aneurysm and affords preoperative study of the nature, extent and precise localization of the lesion. Palliative procedures (viz., radiation of the lesion, surgical decompression, electrocoagulation, and carotid ligation) have proved to be unpredictable and sometimes disastrous as forms of treatment. Surgical extirpation of the aneurysm is the method of choice and the risk involved is considered to be less than the risk of leaving the lesion untreated. Recent adjuncts to neurosurgery (i. e., controlled hypotensive states) can be expected to lower the mortality statistics in the future. Three cases of large cerebral arteriovenous aneurysms treated by surgical extirpation of the lesion are presented. Follow up cerebral arteriography was done to determine the completeness of the removals. Intracerebral hematomas existed in all cases. The progressive nature of the disease was abruptly interrupted and recovery followed without additional neurologic deficit.

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