Multimodal treatment for temporobasal arteriovenous malformation: Case report

Abstract

Background: Arteriovenous malformations (AVMs) are congenital lesions requiring multimodal approach. 
Method: We report a case of a 25 years old woman, with ruptured temporobasal AVM, who required multimodal treatment, emphasizing on treatment options, advantages and disadvantages of each treatment chosen, encountered difficulties, technical considerations and outcome. 
Results: The patient, admitted for the first time in comatose state, underwent emergent surgery with evacuation of an intraparenchymatal hematoma and decompressive craniectomy. After neurological recovery, the patient was thoroughly investigated and positive diagnosis of left temporobasal AVM was established. The patient underwent surgery with subtotal resection of the AVM, followed by Gamma knife stereotactic radiosurgery of the residual nidus. The outcome was favorable. 
Conclusions: AVMs need complex treatment performed in a multidisciplinary team. Surgery is the treatment of choice in management of the AVMs. Gamma knife stereotactic surgery is required if a residual nidus is left in place following surgery. Definitive treatment in AVMs is mandatory because of the high risks of hemorrhage with high morbidity and mortality.