Andrej Mrlian

Giant intranidal aneurysm associated with the arteriovenous malformation.

Saccular aneurysms are frequently associated with arteriovenous malformations (AVMs) probably due to hemodynamic stresses exerted on an arterial wall. The incidence of such an association has been reported between 5.5% and 12% [1,2]. Most of these aneurysms are small or medium sized, giant aneurysms are very rare with only few cases published. Some of the associated aneurysms located on the arterial feeders of the AVM may decrease in size or even disappear completely after the AVM treatment [3]. However, intranidal aneurysms usually venous in origin, require treatment and when treated microsurgically, they should be removed together with the AVM nidus. If the intranidal aneurysm is giant, the complete removal of the AVM becomes even more challenging. Microscope integrated nearinfrared indocyanine green videoangiography (ICG) can be useful in such a situation mainly for intraoperative orientation. Here we present a case report of an AVM associated with giant intranidal aneurysm, which was treated successfully with the aid of intraoperative ICG.