2017 Volume 39 Issue 4 Pages 309-313
Case: A 38-year-old woman had an intraventricular hemorrhage and was diagnosed with parasplenial arteriovenous malformation (AVM) of Spetzler-Martin grade I. V. After embolization with N-butyl-2-cyanoacrylate, Gamma Knife treatment was performed. One year and 7 months later, the patient had a second intraventricular hemorrhage. Cerebral angiography performed 3 months later showed an intranidal aneurysm, and contrast-enhanced magnetic resonance imaging (MRI) showed enhancement of the wall of the intranidal aneurysm. The patient had a third intraventricular hemorrhage 5 months after the second hemorrhage. After Onyx embolization, craniotomy and resection were performed. Conclusion: The incidence of hemorrhage in patients with AVM is higher in those with aneurysms than in those without. Intravascular therapy and radiation therapy are effective in reducing the nidus in patients with parasplenial AVMs with an intranidal aneurysm projecting towards the ventricle. However, strict follow-up is needed because of the higher risk of rebleeding into the ventricle. We could evaluate intranidal aneurysm within the ventricle using contrast-enhanced MRI. In this regard, frequent examination is important for assessing the risk of aneurysm enlargement and bleeding.
