Total temporary occlusion of blood flow for several hours to treat a giant deep arteriovenous malformation: A series of multiple operations to save a young life.
BACKGROUND
The treatment of giant deep arteriovenous malformations (AVMs) remains challenging.


METHODS
We report a case of giant deep AVM diagnosed in a 9-year-old girl, for whom the AVM rupture occurred 9 years later. At the age of 9, the girl developed mild left hemiparesis. Magnetic resonance imaging revealed a giant deep AVM. The patient underwent one course of stereotactic radiotherapy followed by serial imaging. At the age of 18, we admitted her to our department with left hemiparesis and a loss of consciousness. Computed tomography showed intracerebral hemorrhage related to AVM. The treatment process proved challenging, with recurrent intracerebral hemorrhages. During the second operation, we used total temporary occlusion for almost 4 hours. Eventually, after 4 rounds of embolizations, 4 microsurgical operations, and a month-and-a-half after admission, AVM was successfully occluded. Five years after this treatment, the patient regained the ability to walk without assistance, although a moderate disability with visual changes remained (Modified Rankin Scale score 3).


CONCLUSIONS
This case illustrates that the cumulative risk of rupture of a high-grade AVM in young patients is evident, while treatment may prove successful with satisfactory results.
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Pediatric Neurology and Neurosurgery, North-Western State Medical University, Saint-Petersburg, Russia.
Danil A
DA
Kozyrev
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
Behnam Rezai
BR
Jahromi
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
Juha
J
Hernesniemi
Arteriovenous malformation; deep AVM; intracerebral hemorrhage; microneurosurgery