Brainstem arteriovenous malformation with a pedicle aneurysm treated by endovascular surgery and proton-beam radiosurgery--case report

A 39-year-old male presented with a small pontine hemorrhage and subarachnoid hemorrhage. Angiography showed a small left pontine arteriovenous malformation (AVM) associated with a small aneurysm on the pedicle feeding the AVM. The pedicle aneurysm was occluded by microcoils. The AVM was then treated by proton-beam radiosurgery. Follow-up angiography 2 years later revealed that the AVM had disappeared completely without neurological deficit. The combination of embolization and proton-beam radiosurgery was curative in this patient with a pontine AVM associated with an aneurysm on the feeding artery, showing that these techniques can be used to treat inoperable vascular lesions safely.