Monotherapy with microsurgical resection of rupturedSpetzler-Martin grade III+ arteriovenous malformation:a case report

Abstract

Introduction: Spetzler-Martin grade III+ lesions have shown high surgical risk; therefore, conservative management can be considered. However, ruptured presentation in pediatric patients warrants intervention. A case of successful treatment with surgical resection is reported. Case description: A 4-year-old male patient presented to the emergency room with comatose state due to intracranial bleeding with ventricular extension. After emergency management with ventricular drainage, angiographic study revealed a ruptured precentral grade III+ arteriovenous malformation with intranidal aneurysms. Microsurgical resection with
intraoperative digital subtraction angiography was successfully performed without change in neurological status. Conclusion: Individualized management of grade III arteriovenous malformations is warranted. When several clinical and angiographic features are analyzed,
better treatment approaches can be proposed. Some grade III+ lesions are suitable for monotherapy management with surgical resection.