Hemorrhage after embolization and radiosurgery for a cerebral arteriovenous malformation

The patient was a 42-year-old male who presented with an arteriovenous malformation (AVM) in the left temporal lobe. The onset occurred during an epileptic seizure, and the AVM measured 5.4cm in size. At first, embolization was performed, but after embolization, an intranidal aneurysm was also observed. We could not perform an embolization of the aneurysm. Two weeks later, angiography was performed and showed an occlusion of the draining pathways. We performed radiosurgery on the nidus which measured 2.7cm in size. The patient demonstrated no deficit at the time of discharge. Five months later, however, he suddenly suffered from a massive cerebral hemorrhage, and died. This case reinforces the fact that surgery should be performed for an AVM with either an occlusion of the draining pathways or with an intranidal aneurysm.