Abstract
In this paper, a case of successful treatment of arteriovenous malformation (AVM) in the right cerebral hemisphere by direct excision during infancy is presented, along with more than five years of follow-up observation.
A 6-day-old male child suffering from left hemiconvulsion due to a cerebral hemorrhage was admitted to our hospital. In this case, there were no complications during pregnancy or delivery, head circumpherence was normal, and there were no findings of congestive heart failure, retinal hemorrhage, jaundice or hemorrhagic diathesis. The only pertinent finding was a cranial bruit. After admission, a CT scan demonstrated a subcortical hemorrhage with no midline shift and a subsequent enhanced CT scan showed a round mass in the right frontal lobe. A cerebral angiography confirmed this diagnosis by revealing a large high-flow arteriovenous shunt, called an arteriovenous fistula (AVF). This AVF was located on the surface of the right frontal lobe, and was fed principally by the azygos pericallosal artery and drained into the superior sagittal sinus. The patient was treated by conservative therapy and recovered without any further seizures.
Three years later the patient returned to the hospital in a semicomatous state with left exophthlmus following generalized clonic convulsion.
A cerebral angiography showed that the AVF was moderately enlarged compared with the angiography performed three years earlier.
An operation was performed, and three aneurysmal malformations were obliterated and totally excised without interrupting the intrinsic supply of the corpus callosum or both hemispheres. In spite of the marked hemodynamic changes resulting from the surgical undertaking, the child has not suffered from either edema or hemorrhagic infarction.
As a result of the operation, the exophthlmus and the cranial bruit disappeared. Now, at the age of five and a half, the child shows steady physical developement with only slight retardation.
