Intracranial Gorgon: Surgical Case Report of a Large Calcified Brain Arteriovenous Malformation

Abstract

Objective:Rare disease Background:Brain arteriovenous malformations (AVMs) are benign intracranial vascular anomalies that, under certain circumstances, may become life-threatening. Diffuse calcifications found in the vessel walls, interposing tissue or adjacent cerebral parenchyma are not uncommon, however, intense calcifications of AVMs that render them into veritable "brain stones" are scarcely reported in the literature and a genuine neurosurgical nightmare. Case Report:A 55 years-old male patient lacking any personal history of serious morbidities or surgical interventions was referred to our department for several epileptic seizures and severe chronic headache in the parieto-occipital region. Upon clinical examination, the patient was aware, right-handed, and had no motor or sensory deficits. Computed tomography angiography scan showed a large densely calcified frontal AVM. The patient was subjected to neurosurgical removal of the lesion and was discharged a week later with a minor motor deficit of the left arm. Conclusions:Intracranial AVMs are a rare pathology, but a genuine microsurgical trial. The difficulty level soars when the malformed vessels become atherosclerotic and calcified, rendering bipolar ligation or permanent clipping unfeasible. An incomplete resection in the case of a highly calcified lesion can only result in an uncontrollable hemorrhage.

Pediatric intracranial calcified arteriovenous malformation: A case report

“…Calcifications in and around the AVM rendered it more difficult to resect. Florian et al ' s [7] reported of a large calcified brain AVM shares certain similarities with our case. Although their patient was a 55-year-old adult, he also reported seizures and headaches as the manifestation of a large, densely calcified AVM.…”

“…[2,17] However, large solitary or multiple intracranial calcifications, also referred to as "brain stones" or "cerebral calculi, " are less frequently encountered. [8] To the best of our knowledge, few reports of brain stones exist within the literature, [7,8,17] resulting in uncertainty regarding treatment strategies for calcified AVMs. In this report, we present a case of a pediatric patient who was found to have a calcified AVM which was successfully resected.…”

Teaching NeuroImage: Calcifying Pseudoneoplasm of the Neuraxis in the Setting of Hereditary Hemorrhagic Telangiectasia and Seizures

“…Final pathology diagnosed a calcifying pseudoneoplasm of the neuraxis (CAPNON), presumably arising from an AVM remnant. 1 They are rare, slow-growing lesions believed to form secondary to tissue insult. The benefits of this finding over an AVM are 2-fold; cerebral autoregulation is maintained, and future surveillance angiograms are avoidable.…”