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Importance of Diagnostic Imaging Technology in asymptomatic patients and therapeutic imaging approach: Child with ruptured brain AVM

Patient is a female child at age of 10 in good general condition who presented after a mild head trauma. Consequently, she had a headache, stiff neck and vomiting. All of these, led to contusi capitis diagnosis which indicated craniogram, emergency head CT and MR. In general, she is a well-being girl, with no other significant diseases in her or family history. During imaging studies AV-malformation was accidentally found on brain CT scans and proven on both MR and DSA. The AVM is located in ventral right cerebellum and its size is close to 3cm. The main feeders are a right AICA and the left Pica. Venous drainage occurs via an inferior vermian vein. Another finding is a bleeding occurred on the venous outflow. A treatment is justified due to the young age and the previous bleeding. Surgery is difficult in the base of skull location, radiation therapy is restricted in its efficiency due to the size. It is likely that transarterial embolization may lead to ischemic complication, specifically with regard to the close location of cranial nerves. However, there is no doubt that endovascular treatment can cure the patient by associating transvenous to transarterial embolization.