Introduction. Treatment of cerebral arteriovenous malformations is very
challenging and controversial in spite of current recommendations. Surgery is
recommended in patients with hemorrhagic stroke, but in patients with good
neurological status, when symptoms improve rapidly, the risk of surgical
morbidity may be much higher than the risk of rebleeding. Case report. We
report a case of a patient with an intracranial hemorrhage due to a ruptured
arteriovenous malformation located in the right temporal region of the brain.
Because of angiographic and anatomical features of the arteriovenous
malformation (deep location and deep venous drainage, but also small
arteriovenous malformation nidus size), radiosurgery was the preferred
treatment modality. The patient was treated conservatively in the acute
stage, and the arteriovenous malformation was subsequently completely
eradicated with gamma knife radiosurgery. During the 3-year imaging
follow-up, no sings of rebleeding were found. Also, angiography demonstrated
that the arteriovenous malformation was completely excluded from the cerebral
circulation. The patient was in a good condition and presented without
neurological deficits or seizures during the follow-up period. Conclusion.
All treatment modalities carry a risk of neurological compromise, but gamma
knife radiosurgery may be a good option, even in cases with hemorrhagic
presentation. It needs to be mentioned that complete obliteration takes
approximately 1 to 3 years after the treatment, and in some cases it cannot
be obtained.
Spontaneous regression of a mandibular arteriovenous malformation in a 9-year-old boy: Case report with twelve month follow up
