Comprehensive neurosurgical treatment of right occipital arteriovenous malformation with advanced angiographic techniques

/Summary. A 39-year-old female with a notable medical history of smoking and a familial predisposition to unruptured aneurysms presented with clinical symptoms of intermittent right-sided headaches, flashes of light, and pulsatile tinnitus in the right ear. Diagnostic evaluations, including advanced angiographic techniques, identified a right occipital arteriovenous malformation (AVM). The angiogram revealed significant venous flow voids, emphasizing the need for a comprehensive treatment approach. The Spetzler-Martin grading system classified the AVM as Grade 2, indicating a moderate risk profile. A strategic decision was made to undergo partial embolization of two primary arterial feeders from the right posterior cerebral artery (PCA). Subsequent post-embolization angiograms confirmed a marked reduction in arteriovenous shunting, validating the efficacy of the intervention. The surgical approach encompassed an occipital craniotomy, meticulous subarachnoid dissection, and intraoperative angiography to ensure complete resection. Post-operative assessments showcased a successful and complete AVM resection. The patient experienced a brief, transient headache post-surgery, which resolved on its own. She was discharged on the third post-operative day and has since reintegrated into her professional life. However, she reported a minor visual field deficit, which, while noticeable, did not impede her daily activities. This case underscores the importance of a holistic, patient-centric approach in managing AVMs [1-3]. It challenges the conventional wisdom from the ARUBA trial, advocating for a more nuanced, individualized treatment paradigm, especially for young patients with low-grade AVMs [4].