Abstract
In cases of intracranial arteriovenous malformation (AVM) associated with aneurysms, one-stage surgery may be preferable. However, in some cases, it is not easy to determine whether to treat the aneurysms or the AVM first. We present a case of upper vermian hematoma due to a ruptured large AVM of this site associated with two unruptured basilar top aneurysms. These two lesions were successfully treated in 2 separate operations. A 40-year-old female was transferred to our hospital on the 5th day after the onset. On arrival, she was alert, and cerebellar symptoms were minimal. The AVM was fed mainly by the bilateral superior cerebellar arteries (SCA) and drained into the vein of Galen and straight sinus. Two unruptured aneurysms were located at the basilar top and at the origin of the right SCA, respectively. First, the aneurysms were successfully clipped via the right zygomatic approach on the 15th day after the ictus. The postoperative course was uneventful, but right ophthalmoplegia developed. This showed improvement approximately 2 months postoperatively. On the 36th day, a second operation was performed for the AVM via the right occipital transtentorial approach. This approach was suitable for removal of the nidus at this region, but meticulous procedure was needed to preserve perforating arteries feeding the thalamic region, because the patient showed mild hemiparesis and CT and MRI revealed a small infarcted area at the right thalamus.
