Background: Pure arterial malformations (PAMs) are rare vascular anomalies that are commonly mistaken for other vascular malformations. Because of their purported benign natural history, PAMs are often conservatively managed. The authors report the case of a ruptured PAM leading to subarachnoid hemorrhage (SAH) with intraventricular extension that was treated endovascularly.
Observations: A 38-year-old man presented with a 1-day history of headaches and nausea. A computed tomography scan demonstrated diffuse SAH with intraventricular extension, and angiography revealed a right posterior inferior cerebellar artery-associated PAM. The PAM was treated with endovascular Onyx embolization.
Lessons: To the authors' knowledge, only 2 other cases of SAH associated with PAM have been reported. In those 2 cases, surgical clipping was pursued for definitive treatment. Here, the authors report the first case of a ruptured PAM treated using an endovascular approach, showing its feasibility as a treatment option particularly in patients in whom open surgery is too high a risk.
Keywords: AVF = arteriovenous fistula; AVM = arteriovenous malformation; CTA = computed tomography angiography; DSA = digital subtraction angiography; EVD = external ventricular drain; HH = Hunt-Hess; ICU = intensive care unit; MRI = magnetic resonance imaging; PAM = pure arterial malformation; PBD = post-bleed day; PICA = posterior inferior cerebellar artery; SAH = subarachnoid hemorrhage; SOFIA = soft torqueable catheter optimized for intracranial access; endovascular; posterior fossa; pure arterial malformation; subarachnoid hemorrhage.
© 2021 The authors.