Symptomatic De Novo Presentation of Arteriovenous Malformation in Pediatric Patient

The cerebral arteriovenous malformation (AVM) recognized as a congenital lesion traditionally. AVM is an abnormal connection between cerebral artery and vein without capillary and neural structure. Nidus of AVM was located between arteriovenous direct connections. This case report presents newly developed de novo AVM after curative treatment of the initial AVM lesion. The 8-year-old boy was admitted with a small intracranial hemorrhage on medulla oblongata and intraventricular hemorrhage. Nidus of AVM was found on medulla oblongata by trans-femoral cerebral angiography (TFCA). Nidus’s embolization using Oynx (Medtronic, Minneapolis, MN, USA) was performed and complete occlusion was maintained for 4 years. Newly developed AVM was found on a 4-year follow-up TFCA. The de novo AVM is located opposite hemisphere from the initial AVM. New AVM was treated by radiosurgery, and the treatment result is being observed. The de novo AVM is a very rare condition. However, AVM may have a chance to develop in a new location and physicians may have attention to de novo AVM.