Abstract
Background Flow-related aneurysms (FRAs) associated with cerebral arteriovenous malformations
(AVMs) pose a significant therapeutic challenge. Both their natural history and management
strategy are still unclear and underreported. FRAs generally increase the risk of
brain hemorrhage. However, following AVM obliteration these vascular lesions are expected
to disappear or remain stable.
Methods We present two cases where growth of FRAs was detected following complete obliteration
of an unruptured AVM.
Results The first patient presented with proximal middle cerebral artery (MCA) aneurysm growth
after spontaneous and asymptomatic thrombosis of the AVM. In our second case, a very
small aneurysmal-like dilation located at the basilar apex enlarged to a saccular
aneurysm following complete endovascular and radiosurgical obliteration of the AVM.
Conclusion The natural history of flow-related aneurysms is unpredictable. In the cases where
these lesions are not managed first, there should be close follow-up. When aneurysm
growth is evident, active management strategy seems mandatory.
Keywords
aneurysm growth - AVM occlusion - flow-related aneurysms
