Abstract
In this case report, we discuss the microsurgical management of a Spetzler-Martin grade 5 arteriovenous malformation (AVM) in a young boy who presented with a hemorrhagic episode and had a high calculated risk of rebleeding. We also outline the rationale for choosing the management option.
Highlights
As of many tenets exist regarding management of high grade cerebral arterio-venous malformation (AVM) management, making a rigid algorithm impossible to create
We report a microsurgical management of a grade 5 arteriovenous malformation (AVM) in a young patient with a high predicted risk for rebleeding
We identified the major deep draining vein that was looping over the middle cerebral artery (MCA) bifurcation with the help of Indocyanine Green (ICG) venography
Summary
Many tenets exist regarding management of high grade cerebral arterio-venous malformation (AVM) management, making a rigid algorithm impossible to create. We report a microsurgical management of a grade 5 arteriovenous malformation (AVM) in a young patient with a high predicted risk for rebleeding. Post operative angiography revealed complete excision of the AVM with no remaining feeders (Figure 7). The patient followed up in the outpatient clinic 6 months later with minimal pronator drift on the left arm and grade 2 spasticity on his left leg. His blood pressure was rigorously monitored so as not to overshoot the mean arterial pressure above 100 mm of mercury so as to prevent breakthrough perfusion rebleeding.
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