Presentation
Seizures.
Patient Data
Posterior right frontal lobe arteriovenous malformation without hemorrhage or adjacent edema.
Right superior frontal gyrus arteriovenous malformation extending into the right superior frontal sulcus and right precentral sulcus. It contacts the anterior surface of the right precentral gyrus close to the motor cortex location of hand movement.
Medially curvilinear signal loss with blooming on the susceptibility sensitive sequence indicating the presence of blood products/hemosiderin and suggests prior hemorrhage/leak. Minimal surrounding high T2 signal in keeping with a small amount of gliosis.
Arterial supply from dilated branches from the right middle cerebral and anterior cerebral arteries. There is superficial venous drainage via superficial cortical veins to the superior sagittal sinus. There is no MRI evidence of deep venous drainage.
The patient underwent craniotomy and resection.
Histopathology
MICROSCOPIC DESCRIPTION: The sections show a circumscribed nidus of vascular channels surrounded by brain parenchyma. The channels are a mixture of venous and arterial structures. In the central area of the lesion there is a back-to-back arrangement of thin-walled vessels the walls of which are composed entirely of collagen. In the more peripheral zone of the lesion, an arteriovenous fistula is discernible. Brain parenchyma intervening between the larger vascular channels contains collections of hemosiderin-filled macrophages. The overall appearances are of a vascular malformation with combined features of cavernoma and arteriovenous malformation. No evidence of tumor is seen.
DIAGNOSIS: Vascular malformation with combined features of cavernoma and arteriovenous malformation.
Case Discussion
Typical features of an arteriovenous malformation, classified as Spetzler-Martin grade 2.
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