Brainstem arteriovenous malformations (AVMs) are relatively rare among intracranial AVMs, and careful treatment should be planned to resect the nidus of AVM because of high risk of bleeding and high morbidity and mortality after hemorrhage. Moreover, due to the high rebleeding risk in the treatment of brainstem AVM, the nidus should be removed as soon as possible, but surgical resection of brainstem AVMs is difficult and challenging because of their deep-seated location and proximity to vital structures.
We report the case of a 26-year-old female patient who presented with hemorrhagic midbrain AVM, and hydrocephalus due to intraventricular hematoma. We performed removal of the hematoma block in the bilateral, third and fourth ventricle, and surgical resection of the AVM nidus through the anterior interhemispheric transcallosal, trans-third ventricle approach because she experienced repeated hemorrhage after ventricular drainage. The disappearance of the nidus was confirmed with postoperative angiography.
Although radiosurgery should be actually applied to the brainstem AVMs because intrinsic brainstem AVMs are difficult to be resected without causing any serious neurological deterioration, we propose that microsurgical resection through the transcallosal, trans-ventricle approach could be an option for small nidus of brainstem AVM with intraventricular hemorrhagic presentation.