Arteriovenous fistula originating from proximal part of the anterior cerebral artery

Intracerebral arteriovenous fistulas of the brain may be misdiagnosed as arteriovenous malformation. There are only a few reports in the literature about this concept and to the best of our knowledge this is the first case arising from the proximal part of the anterior cerebral artery in association with an aneurysm that ruptured. A 64-year-old man presented with subarachnoid hemorrhage. The patient was neurologically intact. Cerebral angiography and magnetic resonance imaging of the patient revealed a small arteriovenous malformation of the brain involving the region of gyrus rectus and the posteromedial aspect of the orbitofrontal gyrus in addition to an aneurysmal dilatation within the malformation. An arteriovenous fistula arising from the junction of the A1 and A2 segments of the right anterior cerebral artery connected to a vein that has tributaries spreading over the fronto-orbital gyrus and gyrus rectus, were observed during surgery. The patient was successfully treated with clip ligatation of the fistula. Intracerebral arteriovenous fistulas are rare lesions. They may easily be misdiagnosed as arteriovenous malformations. There preoperative consideration in the differential diagnosis can help to decide the most appropriate treatment option.