The rare case of a large complex intraosseous cranial arteriovenous malformation with successful multidisciplinary management

Abstract

Intraosseous cranial arteriovenous malformations (AVMs) are very rare, challenging entities. The authors report the case of an extracranial parietooccipital vascular lesion. A 12-year-old boy presented with accelerated growth of a right scalp lesion over a few months. Digital subtraction angiography showed a large, right parietooccipital intraosseous AVM with multiple complex arterial feeders. Treatment of these lesions is difficult and can necessitate a multidisciplinary approach. In the featured case, 6 embolization procedures were performed over 1 year, including both transarterial and transvenous approaches, followed by total resection. The authors describe what is thought to be the second case of an AVM originating in the cranial bones and the first case with successful multidisciplinary management.

Keywords: AVM = arteriovenous malformation; ECA = external carotid artery; MMA = middle meningeal artery; NBCA = N-butyl cyanoacrylate; OccA = occipital artery; STA = superficial temporal artery; angiography; arteriovenous malformation; embolization; intraosseous; neurological surgery; vascular disorders.