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
There was coating of vessel along the middle cerebral artery (MCA) territory (Figure 2) and hyperdensity along the deep venous territory
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. There was coating of vessel along the middle cerebral artery (MCA) territory (Figure 2) and hyperdensity along the deep venous territory. A four-vessel diagnostic carotid angiography revealed Grade 5 Spetzler-Martin AVM in the right insular territory with feeders from lenticulostiates of the middle cerebral artery (Figure 3). Multiple factors such as young age at presentation, the fact that the lesion had bled, presentation of patient with deficits associated with the lesion on the non-dominant side, presence of deep venous drainage and intra-nidal aneurysm led to a high calculated risk for rebleeding in the patient. After explanation of the risks of the treatment and role of adjuvants in the form of radiosurgery and embolisation the patient was taken up for microsurgical excision. The patient was advised to continue Na Valproate 300 mg orally three times a day for at least a year
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