Usefulness of Direct and Neuroendoscopic Surgery for Ruptured Arteriovenous Malformation with Massive Intraventricular Hemorrhage

Abstract

We report a case of ruptured recurrent arteriovenous malformation (AVM) treated with endoscopic evacuation of massive intraventricular hemorrhage (IVH) following radical resection of AVM in the acute phase. A 45-year-old man was transferred to our hospital in coma. He had been treated for a ruptured AVM at the age of 8. Computed tomography (CT) and CT angiography showed massive IVH and intraparenchymal hemorrhage (IPH) in the left temporal and occipital lobes, with abnormal vessels surrounding the hemorrhage. We diagnosed a ruptured recurrent AVM, and initially evacuated the IVH in both the anterior horn and third ventricle using neuroendoscopy. We subsequently removed the residual IPH and IVH and resected the AVM. Neurological symptoms gradually improved, and the modified Rankin scale score was 2 on discharge. Endoscopic evacuation was useful in a case of ruptured AVM with massive IVH.