Surgical treatment of grade 5 arteriovenous malformation in a girl

We report on a case of a 12-year-old girl that was admitted under our care complaining of headache for over a month which was accompanied by vomiting and diplopia over the last 10 days. On neurological examination a right upper limb tremor and cervical rigidity were noted. CT and MRI scan was performed and revealed a giant left frontotemporal lesion. The lesion was heterogenous with calcifications and hemosidirin, surrounded by brain swelling and causing midline shift. There was little enhancement after gadolinium administration. The last finding led us to consider the presence of a vascular abnormality as a possible diagnosis. The patient was operated upon via a left fronto-temporal craniotomy. We managed to excise the lesion totally. Histopathology revealed the presence of an AVM. Postoperatively the patient was neurologically intact but a subcutaneous collection of CSF was noted that was successfully treated by drainage. Although surgical treatment of deeply seated giant AVM's in the dominant hemisphere of speech and motor-sensory area have a relative high proportion of postoperative neurological deficit, careful surgical intervention can produce excellent outcome.