Extracranial arteriovenous malformation mimicking a peripheral nerve tumor: illustrative case

J Neurosurg Case Lessons. 2024 Mar 18;7(12):CASE23542. doi: 10.3171/CASE23542. Print 2024 Mar 18.

Abstract

Background: Arteriovenous malformations (AVMs) are vascular malformations that are more commonly found intracranially, followed by the head, neck, limbs, and trunk. Extracranially, AVMs can mimic peripheral nerve tumors, leading to misdiagnosis.

Observations: A 19-year-old female, who presented with left lateral lower leg pain, was preoperatively thought to have a peripheral nerve tumor; at surgery, however, she was found to have an extracranial AVM. The distinct margins of the tumor on preoperative magnetic resonance imaging suggested that the patient might have a peripheral nerve tumor; however, the clinical symptoms of focal pain at rest and the absence of Tinel's sign should have raised questions about this diagnosis.

Lessons: This case highlights the difficulty in differentiating a peripheral nerve tumor from an extracranial AVM in certain clinical scenarios. It is important to use a multifaceted diagnostic approach to get a correct preoperative diagnosis and plan treatment appropriately.

Keywords: Tinel’s sign; arteriovenous malformation; magnetic resonance imaging; palpable mass; peripheral nerve tumor.