Hemorrhaged pineal arteriovenous malformation in an older adult patient: Case report and literature review

We present a case of a pineal arteriovenous malformations (AVMs) with intraventricular hemorrhage and hydrocephalus in an older adult patient. Imaging revealed a 7 mm nidus of the pineal region, fed by the posterolateral choroidal arteries (PLChA) and draining into the confluence of the sinuses. A 2 mm distal flow-related aneurysm of the PLChA is identified. Linear-accelerator-based stereotactic radiosurgery was used to treat the nidus and aneurysm. Four months later, MR angiography revealed the disappearance of the aneurysm. The patient remained rebleed-free for 4 years until death. This case features rare elements: late-onset hemorrhage, radiotherapy for flow-related aneurysms, and rapid postirradiation aneurysm resolution.