# Unmasking a Rare Venous-Predominant Arteriovenous Malformation: A Case of Recurrent Subarachnoid Hemorrhage Successfully Treated With Stereotactic Radiosurgery

## TL;DR

A rare venous-predominant arteriovenous malformation in a young man was successfully treated with stereotactic radiosurgery after being misdiagnosed as a benign anomaly.

## Contribution

Demonstrates the long-term efficacy of stereotactic radiosurgery for a rare, high-risk vascular lesion previously misdiagnosed.

## Key findings

- The patient experienced complete AVM resolution on angiography 55 months after SRS.
- Advanced imaging was crucial in distinguishing the rare AVM subtype from a developmental venous anomaly.
- Multidisciplinary decision-making was essential due to the lesion's high surgical risk.

## Abstract

Arteriovenous malformations (AVMs) are a leading cause of intracranial hemorrhage in young adults, yet venous-predominant AVMs remain exceedingly rare and diagnostically challenging, often mimicking benign developmental venous anomalies (DVAs). We present the case of an 18-year-old male who suffered from recurrent subarachnoid hemorrhages due to a venous-predominant AVM initially misidentified as a DVA. Given the lesion’s deep location and high surgical risk, stereotactic radiosurgery (SRS) was selected as the primary treatment modality. Over a 64-month follow-up, the patient demonstrated progressive obliteration of the AVM, culminating in complete resolution on conventional angiography at 55 months post-SRS. This case underscores the critical role of advanced imaging in distinguishing rare AVM subtypes, the importance of multidisciplinary decision-making, and the long-term efficacy of SRS in managing high-risk vascular lesions.