title: Ruptured tectal arteriovenous malformation demonstrated angiographically after removal of an unruptured occipital lobe arteriovenous malformation.
abstract: We report a case of ruptured tectal arteriovenous malformation (AVM) that was demonstrated angiographically only after removal of an unruptured occipital AVM. A 57-year-old man presented with sudden onset of diplopia and tinnitus. Computed tomography revealed a small hemorrhage in the right tectum mesencephali with intraventricular hemorrhage. Magnetic resonance imaging and angiography disclosed AVM in the right occipital lobe which was separate from the hemorrhagic lesion. Angiography demonstrated that the right occipital AVM was fed by the parieto-occipital artery and drained into the superior sagittal sinus and vein of Galen. However, no abnormal vascular lesion was detected near the tectum mesencephali. As venous hypertension was considered the reason for hemorrhage, the occipital AVM was completely resected. Postoperative angiography demonstrated disappearance of the occipital AVM, but it also disclosed a small tectal AVM fed by branches from the superior cerebellar artery, which had not been detected on preoperative angiography. This was considered the true cause of hemorrhage, and gamma knife surgery was accordingly performed. Even if an AVM is demonstrated, if the lesion does not correspond to the hemorrhage we recommend serial angiographical evaluation so that a small AVM is not missed.
authors.affiliation: Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan. fkomatsu@fukuoka-u.ac.jp
authors.forename: Fuminari
authors.initials: F
authors.lastname: Komatsu
authors.forename: Seisaburou
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takemura
authors.forename: Masani
authors.initials: M
authors.lastname: Nonaka
authors.forename: Mika
authors.initials: M
authors.lastname: Ohta
authors.forename: Shinya
authors.initials: S
authors.lastname: Oshiro
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsugu
authors.forename: Takeo
authors.initials: T
authors.lastname: Fukushima
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
mesh_terms: D002533:Cerebral Angiography; D004172:Diplopia / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D016634:Radiosurgery; D012422:Rupture, Spontaneous; D003336:Tectum Mesencephali / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014012:Tinnitus / Q000209:etiology; D014057:Tomography, X-Ray Computed