Feeding artery pedicle aneurysms: association with parenchymal hemorrhage and arteriovenous malformation in the brain

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Abstract
The association between arteriovenous malformations (AVM's) and aneurysms is well documented in the literature. However, a specific type of aneurysm, termed a "pedicle" aneurysm, has received little attention despite its role as a primary source of hemorrhage. The authors report four recent cases of patients with cerebral AVM's who bled from aneurysms arising from the midportion of AVM-feeding artery pedicles. Angiography, computerized tomography, and magnetic resonance imaging confirmed the origin of the hemorrhage from the pedicle aneurysm in each case. Because pedicle aneurysms are at risk for recurrent rupture, they represent an important subclassification of aneurysms associated with AVM's. The authors have expanded the previous classification systems for aneurysms associated with AVM's to include pedicle aneurysms; this classification is based on the location of the aneurysm and its relationship to the malformation. Complete documentation of such aneurysms as the potential source of hemorrhage is recommended, and prompt intervention by embolization and/or surgical resection is indicated for this dangerous aneurysm associated with cerebral AVM's.