{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T17:44:04Z","timestamp":1775324644661,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the University of Medicine and Pharmacy Carol Davila, through the institutional program Publish not Perish"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Arteriovenous malformations (AVMs) are high-risk cerebrovascular anomalies that can lead to devastating complications, especially when associated with intracranial aneurysms. Their coexistence poses unique challenges in diagnosis and management due to heightened hemodynamic stress and rupture risks. This case presents a 35-year-old woman with a giant unruptured left frontal AVM and a bilobed posterior communicating artery (PComA) aneurysm, highlighting the critical role of advanced imaging, meticulous surgical planning, and individualized care in addressing complex cerebrovascular conditions. Methods: The patient presented with a generalized tonic\u2013clonic seizure, her first-ever neurological event. Advanced imaging, including digital subtraction angiography and 3D rotational imaging, revealed a 3\u20134 cm AVM supplied by the left middle and anterior cerebral arteries, with venous drainage into the superior sagittal sinus. Additionally, an unruptured bilobed PComA aneurysm was identified. Given the AVM\u2019s large size, high-flow dynamics, and significant rupture risk, surgical resection was prioritized. The aneurysm, being stable and anatomically distinct, was managed conservatively. Microsurgical techniques were employed to ensure complete AVM resection while preserving critical vascular and neurological structures. Results: Postoperative angiography confirmed the complete removal of the AVM without residual nidus or abnormal vascular connections. The patient recovered without complications, achieving seizure freedom and preserved neurological function. At the three-month follow-up, imaging showed a stable resection cavity and a hemodynamically stable aneurysm. Conclusions: This case demonstrates the power of multidisciplinary care and advanced neurosurgical techniques in achieving curative outcomes for complex cerebrovascular anomalies. It underscores the importance of risk-prioritized strategies and highlights emerging directions for the field, including AI-integrated imaging, hybrid treatment approaches, and long-term studies on hemodynamic stability post-resection. This case contributes valuable insights into optimizing outcomes for patients with coexisting AVMs and aneurysms, offering hope for those facing similarly challenging diagnoses.<\/jats:p>","DOI":"10.3390\/jcm14041232","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T05:10:22Z","timestamp":1739423422000},"page":"1232","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Comprehensive Management of a Giant Left Frontal AVM Coexisting with a Bilobed PComA Aneurysm: A Case Report Highlighting Multidisciplinary Strategies and Advanced Neurosurgical Techniques"],"prefix":"10.3390","volume":"14","author":[{"given":"Corneliu","family":"Toader","sequence":"first","affiliation":[{"name":"Department of Neurosurgery \u201cCarol Davila\u201d, University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matei","family":"Serban","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery \u201cCarol Davila\u201d, University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"},{"name":"Puls Med Association, 051885 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Razvan-Adrian","family":"Covache-Busuioc","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery \u201cCarol Davila\u201d, University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"},{"name":"Puls Med Association, 051885 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mugurel Petrinel","family":"Radoi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery \u201cCarol Davila\u201d, University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru Vlad","family":"Ciurea","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery \u201cCarol Davila\u201d, University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania"},{"name":"Medical Section, Romanian Academy, 010071 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolaie","family":"Dobrin","sequence":"additional","affiliation":[{"name":"\u201cNicolae Oblu\u201d Clinical Hospital, 700309 Iasi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.wneu.2023.08.047","article-title":"Rupture-Risk Stratifying Patients with Cerebral Arteriovenous Malformations Using Quantitative Hemodynamic Flow Measurements","volume":"179","author":"Nico","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1161\/STROKEAHA.124.046725","article-title":"Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations","volume":"55","author":"Samaniego","year":"2024","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Alfter, M., Albi\u00f1a-Palmarola, P., Cimpoca, A., D\u00edaz-Peregrino, R., Jans, P., Ganslandt, O., K\u00fchne, D., and Henkes, H. (2023). Multi-Stage Treatment for Spetzler\u2013Martin Grades III, IV, and V Arteriovenous Malformations: Preoperative Embolization and Microsurgical Resection in a Consecutive Series of 250 Patients. J. Clin. Med., 12.","DOI":"10.3390\/jcm12185990"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Askarova, A.E., and Zhurkabayeva, B.D. (2024). Hemorrhagic stroke in children. J. Cent. Nerv. Syst. Dis., 16.","DOI":"10.1177\/11795735241289913"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Panagiotopoulos, E., Stefanou, M.-I., Magoufis, G., Safouris, A., Kargiotis, O., Psychogios, K., Vassilopoulou, S., Theodorou, A., Chondrogianni, M., and Bakola, E. (2024). Prevalence, diagnosis and management of intracranial atherosclerosis in White populations: A narrative review. Neurol. Res. Pract., 6.","DOI":"10.1186\/s42466-024-00341-4"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3390\/neurolint16010005","article-title":"The Management of Intracranial Aneurysms: Current Trends and Future Directions","volume":"16","author":"Deshmukh","year":"2024","journal-title":"Neurol. Int."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chauvet, G., El Aouni, M.C., Magro, E., Sabardu, O., Ben Salem, D., Gentric, J.-C., and Ognard, J. (2024). Diagnostic Accuracy of Non-Contrast-Enhanced Time-Resolved MR Angiography to Assess Angioarchitectural Classification Features of Brain Arteriovenous Malformations. Diagnostics, 14.","DOI":"10.3390\/diagnostics14151656"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"de Oliveira Souza, N.V., Lima, V.M., Rouchaud, A., Saleme, S., and Mounayer, C. (2025). Transvenous embolization of brain arteriovenous malformations featuring multiple draining veins with 4D-DSA: A case series and technical insights. J. NeuroInterv. Surg.","DOI":"10.1136\/jnis-2024-022335"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Renedo, D., Rivier, C.A., Koo, A.B., Sujijantarat, N., Clocchiatti-Tuozzo, S., Wu, K., Torres-Lopez, V.M., Huo, S., Gunel, M., and de Havenon, A. (2024). APOE \u03b54 and Intracerebral Hemorrhage in Patients with Brain Arteriovenous Malformation. JAMA Netw. Open, 7.","DOI":"10.1001\/jamanetworkopen.2023.55368"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Miron, I., Prun\u0103, V.M., Visarion, D.M., Petrescu, G.E.D., and Gorgan, R.M. (2024). Natural History and Predictors for Hemorrhage in Supratentorial Brain Arteriovenous Malformations. J. Clin. Med. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133760"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Huang, P.-W., Peng, S.-J., Pan, D.H.-C., Yang, H.-C., Tsai, J.-T., Shiau, C.-Y., Su, I.-C., Chen, C.-J., Wu, H.-M., and Lin, C.-J. (2024). Vascular compactness of unruptured brain arteriovenous malformation predicts risk of hemorrhage after stereotactic radiosurgery. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-54369-2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2712","DOI":"10.21037\/qims-22-750","article-title":"Advances in differential diagnosis of cerebrovascular diseases in magnetic resonance imaging: A narrative review","volume":"13","author":"Li","year":"2023","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Li, X., Xiang, S., and Li, G. (2024). Application of artificial intelligence in brain arteriovenous malformations: Angioarchitectures, clinical symptoms and prognosis prediction. Interv. Neuroradiol.","DOI":"10.1177\/15910199241238798"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Huang, C.-W., Lee, C.-H., Chung, K.-C., and Tsuei, Y.-S. (2023). Feasibility and workflow analysis of IV-DSA-based augmented reality-guided brain arteriovenous malformation resection in a hybrid operating room: I-Flow tailored method. J. NeuroInterv. Surg.","DOI":"10.1136\/jnis-2023-020797"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e614","DOI":"10.1016\/j.wneu.2023.03.149","article-title":"Hyperspectral Imaging in Brain Tumor Surgery\u2014Evidence of Machine Learning-Based Performance","volume":"175","author":"Puustinen","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1097\/JS9.0000000000001847","article-title":"Intraoperative fluorescence redefining neurosurgical precision","volume":"111","author":"Regmi","year":"2024","journal-title":"Int. J. Surg. Lond. Engl."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1136\/jnis-2023-020142","article-title":"Preoperative embolization of brain arteriovenous malformation and efficacy in intraoperative blood loss reduction: A quantitative study","volume":"16","author":"Brunozzi","year":"2024","journal-title":"J. NeuroInterv. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e254","DOI":"10.1016\/j.wneu.2023.07.040","article-title":"Deliberately Staged Combined Endovascular Embolization and Subsequent Microsurgery Resection for the Treatment of Cerebral Arteriovenous Malformations","volume":"178","author":"Zhang","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.wneu.2022.11.058","article-title":"The Era of Onyx Embolization: A Systematic and Literature Review of Preoperative Embolization Before Stereotactic Radiosurgery for the Management of Cerebral Arteriovenous Malformations","volume":"170","author":"Letchuman","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Pal, A., Blanzy, J., G\u00f3mez, K.J.R., Preul, M.C., and Vernon, B.L. (2023). Liquid Embolic Agents for Endovascular Embolization: A Review. Gels, 9.","DOI":"10.3390\/gels9050378"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lim, J.H., and Kim, M.J. (2024). Considerations for the Use of Stereotactic Radiosurgery to Treat Large Arteriovenous Malformations. Biomedicines, 12.","DOI":"10.3390\/biomedicines12092003"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1227\/neu.0000000000002308","article-title":"Comparison of Single-Session, Neoadjuvant, and Adjuvant Embolization Gamma Knife Radiosurgery for Arteriovenous Malformation","volume":"92","author":"Kim","year":"2023","journal-title":"Neurosurgery"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e583","DOI":"10.1016\/j.wneu.2024.05.169","article-title":"Embolization Prior to Radiosurgery in Treatment of Arteriovenous Malformations: Defining Radiosurgery Target Dose with Nidal Volume Reduction","volume":"188","author":"Young","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_24","first-page":"1078","article-title":"Surgery in Intracerebral Arteriovenous Malformations: The Role of Preoperative Embolization","volume":"33","author":"Ozden","year":"2023","journal-title":"Turk. Neurosurg."},{"key":"ref_25","first-page":"872","article-title":"Hybrid Operating Room for the Treatment of Spetzler-Martin Grade III-V Brain Arteriovenous Malformation: An Institutional Experience","volume":"34","author":"Cheng","year":"2024","journal-title":"Turk. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"8798","DOI":"10.21037\/qims-24-1150","article-title":"Hemodynamic relationship with angioarchitecture of cerebral arteriovenous malformation and changes after embolization: A pilot study by 4D flow MR","volume":"14","author":"Wang","year":"2024","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Iwaki, K., Arimura, K., Nishimura, A., and Iihara, K. (2021). Decompression surgery for pure arterial malformations in a 15 year old with acute, progressive visual impairment: Illustrative case. J. Neurosurg. Case Lessons, 1.","DOI":"10.3171\/CASE2037"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"515","DOI":"10.25259\/JNRP_55_2024","article-title":"Pure arterial malformation: Reports of two rare cases","volume":"15","author":"Vats","year":"2024","journal-title":"J. Neurosci. Rural Pract."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Etame, A.B., Bentley, J.N., and Pandey, A.S. (2013). Acute expansion of an asymptomatic posterior communicating artery aneurysm resulting in oculomotor nerve palsy. Case Rep., 2013.","DOI":"10.1136\/bcr-2013-010134"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Al-Abdulwahhab, A.H., Al-Sharydah, A.M., Al-Suhibani, S.S., Almulhim, A.S., Al-Dhafeeri, O.M., and Al-Jubran, S.A. (2020). A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: A case report and literature review. BMC Neurol., 20.","DOI":"10.1186\/s12883-020-01682-8"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Yasuda, T., Maki, Y., Ishibashi, R., Kurosaki, Y., Chin, M., and Yamagata, S. (2019). Distal posterior inferior cerebellar artery aneurysm with cerebellar arteriovenous malformation treated by open surgery: A case report. Chin. Neurosurg. J., 5.","DOI":"10.1186\/s41016-019-0161-z"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Toader, C., Radoi, M.P., Ilie, M.-M., Covache-Busuioc, R.-A., Buica, V., Glavan, L.-A., Covlea, C.-A., Corlatescu, A.D., Costin, H.-P., and Crivoi, C. (2024). Clinical Presentations and Treatment Approaches in a Retrospective Analysis of 128 Intracranial Arteriovenous Malformation Cases. Brain Sci., 14.","DOI":"10.3390\/brainsci14111136"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1232\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:32:51Z","timestamp":1760027571000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/4\/1232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,13]]},"references-count":32,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14041232"],"URL":"https:\/\/doi.org\/10.3390\/jcm14041232","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,13]]}}}