Hybrid Operation of a Ruptured Aneurysm Associated with a Developmental Venous Anomaly

As a normal variation of the cerebral venous angioarchitecture, developmental venous anomalies (DVAs) represent a rare cause of intraparenchymal hemorrhage. Different from mixed vascular lesions, such as capillary malformations, arteriovenous malformations, arteriovenous fistulas, and thrombosis, here we describe the first case of a ruptured hemodynamic aneurysm associated with a DVA and introduce the first use of hybrid operation for the treatment of a hemorrhagic DVA.

A 14-year-old girl suffered from sudden onset of headache, aphasia, and left hemiplegia. On the way of her transfer to our center, she suddenly fell into a coma. Computed tomography scan demonstrated an enlarged intraparenchymal hemorrhage in the left temporal lobe. Angiography revealed a large frontal DVA with an associated hemodynamic aneurysm. Superselective angiography of left middle cerebral artery confirmed that the aneurysm was located on the turning site of arteriovenous transition.

Considering the large hematoma and the possible occlusion of surrounding collecting veins, we attempted transarterial embolization but were unsuccessful. Hematoma evacuation and aneurysm isolation were performed in a hybrid operation room. Intraoperative angiography was used to confirm the location of the aneurysm and to recheck the result. The patient woke up 1 day later and the symptoms were relieved entirely 1 year later.

Associated aneurysm may be a cause of intraparenchymal hemorrhage in DVAs and routine imaging monitoring is needed. Hybrid operation is a possible treatment for such complicated mixed lesions in DVA, which proved to be safe and effective in this patient.