In this paper, a case is reported in which a deep-seated arteriovenous malformation (AVM) was successfully removed from the frontal baso-medial region. AVM's located on the medial aspect of the cerebral hemisphere represent 4-15% of the total AVM's reported in the literature. These AVM's require special attention because of their obscure location, the close proximity to the critical area and the difficulties encountered in their resection.
A 41-year-old man was admitted because of a sudden onset of headache and vomiting. He was in a stuporous state with stiffness of the neck and left hemiparesis. A plain CT scan revealed right frontal hemorrhage and a clot was also seen in the ventricles. A right carotid angiogram showed an AVM, which involved the right rectal gyrus and subcallosal area, extending to the anterior hypothalamus. The AVM was supplied by branches arising from the right anterior cerebral artery (A1 and A2 segments), with drainage into the basal vein of Rosenthal.
The patient made a good recovery with bilateral ventricular drainages. A right frontal craniotomy was done two weeks after admission. The AVM was exposed through the interhemispheric parafalx approach and excised using micro'surgical technique without any new neurological deficits excepting a transient diabetes insipidus. A postoperative digital subtraction angiogram showed no residual AVM. The patient then developed, evidence of a communicating hydrocephalus and a ventriculo-peritoneal shunt was performed. Although recent memory was impaired, he exhibited gradual improvement and was able to return to work.
