Cerebral Arteriovenous Malformation: Varicose Transformation Complicated by Viral Encephalitis against a Background of Radiosurgical Treatment

D.V. Svistov, K.P. Plotnikov, D.V. Kandyba

(Faculty of Neurosurgery, Kirov Medicomilitary Academy, Saint Petersburg)

Male patient A., aged 14, was admitted to the clinic in February of 2004. He suffered from rare generalized seizures during 2.5 years. Small arteriovenous malformation (AVM) of the left parietal lobe was diagnosed in 2001. A course of radiosurgery was carried out in 2002. The subsequent 20 months were characterized by more frequent seizures and more violent headache. MRI-examination was indicative of intracerebral hemorrhage from AVM. Complex examination revealed varicose transformation of partially obliterated small convexital AVM. The varix diameter was up to 35 mm. Trephination of the skull in the left parietal area and AVM removal were performed on November 17, 2004. There was postoperative intracerebral hematoma in the cavity, which appeared after removal of a varicose node. Conservative treatment resulted in regression of symptoms. However, 3 weeks later the patient was admitted to the clinic once again due to augmentation of focal symptoms, conditioned by an increase of a volume of infected hematoma up to 50 cm3. The patient was reoperated. Decompressive trephination of the skull in the left parietal area and hematoma removal were made. Despite treatment one could watch hypertensive syndrome and lobar edema of the brain. Virologic examination revealed viral encephalitis (Epstein-Barr virus). Antiviral therapy led to complete regression of symptoms and brain edema. Cranioplasty was performed in December of 2004.

The demonstration goal was to show a favorable outcome of multimodality treatment of such a rare complication, which developed after radiosurgery of convexital AVM, as varicose transformation of small AVM and viral encephalitis.