Case report: Surgical treatment of combined dural arteriovenous fistula and angiographically occult arteriovenous malformation complicated by intracerebral hemorrhage

Background. Cerebral arteriovenous malformations and dural arteriovenous fistulas are relatively rare pathologies with frequency of 1–1.5 and 0.1–0.2 cases per 100 000 people per year, respectively. Probability of a combination of these pathologies in a single patient is extremely low. The authors were not able to find publications describing a combination of these pathologies of the cerebral vasculature.Aim. To present a clinical case of successful surgical treatment of combined cerebral pathology – dural arteriovenous fistula and angiographically occult arteriovenous malformation – in a patient with intracranial hemorrhage.Materials and methods. Analysis of the results of treatment of patient with dural arteriovenous fistula with hemorrhagic disease course at the N.V. Sklifosovsky Research Institute of Emergency Medicine (Moscow) was performed. The patient underwent osteoplastic cranial trepanation, resection of the dural arteriovenous fistula. Intraoperatively an angiographically occult arteriovenous malformation was detected which caused the hemorrhage.Results. Surgical treatment allowed to achieve a satisfactory outcome. Intraoperatively diagnosed angiographically occult arteriovenous malformation was confirmed histologically.Conclusions. The presented clinical observation shows the necessity of careful revision of hematoma cavity in the presence of isolated intraparenchymal hemorrhage from dural arteriovenous fistula.