A Case of Choroidal Arteriovenous Malformation Presenting with Intraventricular Hemorrhage: Successful Resection via High Occipital Transcortical Approach

Background: Choroidal arteriovenous malformations (AVMs) are exceedingly rare vascular lesions that often present with hemorrhage owing to their deep-seated location and complex angioarchitecture.Case Description: A 70-year-old woman presented with an unknown-onset headache and impaired consciousness.Computed tomography revealed massive intraventricular hemorrhage with acute hydrocephalus.Digital subtraction angiography revealed a choroidal AVM in the right trigonal region, fed by the anterior choroidal arteries.An external ventricular drain was placed immediately.Two weeks after neurological improvement, microsurgical resection was performed using a high occipital transcortical approach.Complete resection of the AVM nidus was achieved while preserving the surrounding structures.Postoperative MRI and MRA confirmed complete obliteration.The patient recovered without any neurological deficits, and at 3-month follow-up remained neurologically intact without evidence of rebleeding. Conclusion:Although rare, choroidal AVMs can present as intraventricular hemorrhages in elderly patients.This case highlights the feasibility of a high occipital transcortical approach for deep-seated choroidal AVMs and emphasizes the importance of meticulous surgical planning to achieve complete and safe resection.