Published online Jul 16, 2015. doi: 10.12998/wjcc.v3.i7.661
Peer-review started: September 30, 2014
First decision: October 28, 2014
Revised: February 5, 2015
Accepted: April 16, 2015
Article in press: April 20, 2015
Published online: July 16, 2015
Processing time: 300 Days and 3.6 Hours
We describe a rare case of an arteriovenous malformation (AVM) embedded in the vestibulocochlear nerve presenting with subarachnoid hemorrhage (SAH) treated by microsurgical elimination of the main feeding artery and partial nidus volume reduction with no permanent deficits. This 70-year-old woman was incidentally diagnosed 4 years previously with two small unruptured tandem aneurysms (ANs) on the right anterior inferior cerebral artery feeding a small right cerebellopontine angle AVM. The patient was followed conservatively until she developed sudden headache, nausea and vomiting and presented to our outpatient clinic after several days. Magnetic resonance imaging demonstrated findings suggestive of early subacute SAH in the quadrigeminal cistern. A microsurgical flow reduction technique via clipping between the two ANs and partial electrocoagulation of the nidus buried within the eighth cranial nerve provided radiographical devascularization of the ANs with residual AVM shunt flow and no major deficits during the 2.5 year follow-up. This is only the second report of an auditory nerve AVM. In the event of recurrence, reoperation or application of alternative therapies may be considered.
Core tip: Arteriovenous malformations (AVMs) originating within or impinging on cranial nerves are extremely rare, and there is an increased risk of hemorrhage in AVMs associated with aneurysms. The authors describe the second report of a patient with a vestibulocochlear nerve AVM who presented with subarachnoid hemorrhage. A discussion of the delicate diagnostic and therapeutic implications is presented.