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|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 5 | Page : 792-794
Arteriovenous malformation at the corpus callosum with an intraventricular aneurysm
Masaru Honda1, Takeo Anda1, Toshiaki Kamei2
1 Department of Neurosurgery, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu, 744-0033 Yamaguchi, Japan
2 Department of Pathology, Tokuyama Medical Association Hospital, Shunan City, Yamaguchi, Japan
|Date of Web Publication||6-Oct-2015|
Department of Neurosurgery, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu, 744-0033 Yamaguchi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Honda M, Anda T, Kamei T. Arteriovenous malformation at the corpus callosum with an intraventricular aneurysm. Neurol India 2015;63:792-4
Arteriovenous malformations (AVMs) sometimes trigger an intraventricular hemorrhage (IVH).
A corpus callosal AVM without a radiologically distinguishable nidus is rare. We report our experience with a callosal AVM with an intraventricular aneurysm ( IVA), the nature of which was serially unveiled by neuroradiological studies.
A 29-year-old man suddenly experienced severe headache and vomiting. Computed tomography (CT) revealed a hematoma at the corpus callosum which resulted in an intraventricular hemorrhage (IVH) in lateral, third, and fourth ventricles [Figure 1]. CT angiography and digital subtraction angiography (DSA) revealed that three small arteries originated from the distal anterior cerebral artery and rapidly drained into the left septal and internal cerebral veins. A second digital subtraction angiogram (DSA) 1 week after the onset of symptoms detected an aneurysm from a small branch of the left distal anterior cerebral artery near the malformation [Figure 2]. Two weeks later, total resection of this pseudoaneurysm was performed. Anterior corpus callosotomy led to the evacuation of hematoma and complete resection of aneurysm [Figure 3]. It also led to the disappearance of all abnormal vessels [Figure 2].
|Figure 1: Axial computed tomography scan revealed hemorrhage in the lateral ventricles and corpus callosum|
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|Figure 2: (a–d) Digital subtraction angiography: (a) Left internal carotid angiography (three-dimensional angiographic reconstruction), lateral oblique view revealed small arteries from the A3 portion of the left anterior cerebral artery (arrows) and early draining into the left septal vein and internal cerebral vein (arrowhead). (b) A second left internal carotid angiography (three-dimensional angiographic reconstruction, with magnification), left oblique view, revealed an aneurysm arising from the small arterial branch of the distal anterior cerebral artery [the feeding arteries (arrows), and the draining vein (arrowhead)]. (c) A third left internal carotid angiography, lateral view, prior to surgery revealed a partially thrombosed aneurysm (circle). (d) The intraoperative angiography, left oblique view, demonstrated no opacification of feeding arteries, aneurysm, and draining veins|
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|Figure 3: (a and b) Intraoperative microscopic photograph: (a) The aneurysm was dissected through an opened corpus callosum. (b) Feeding arteries around the nidus were coagulated but the nidus was difficult to completely excise and was left in situ after complete coagulation|
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In the case of an isolated callosal hematoma and/or IVH, moyamoya disease, AVM, infection, or trauma are suspected.,,,, A corpus callosal AVM occurs mainly at the splenium, fed by anterior or posterior cerebral arteries, and drains into the superior sagittal sinus or the great vein of Galen. The most common presenting symptom was subarachnoid hemorrhage. There are only 5 cases of IVA associated with an AVM including the present case.,,, Surgery was performed in 4 out of the five cases.
IVAs are frequently very small and the parent arteries are also compressed by the IVH and therefore, these aneurysms are not always detected during the acute stage., Therefore, in the presence of an IVH, serial CT angiography or DSA is mandatory.,,,, To identify and trace the feeding artery, nidus and aneurysm, an intraoperative DSA is very useful, especially when indocyanine green angiography is not available, as occurred in our case.
The choice between clipping or resection of the IVA depends on the size of the parent artery. Clipping of a pseudoaneurysm is challenging and resection is well suited for an IVA located on a small parent vessel. Surgery also helps in evacuation of the hematoma and helps in preventing hydrocephalus. Embolization may also be performed in selected cases. Most AVMs and IVAs are located within deeper structures and arise from small branches; therefore, it may be difficult to navigate microcatheters into them.,
We thank the radiology technician Toshimitsu Ikeda for selecting and providing the neuroradiological figures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]