Resection of arteriovenous malformation in a patient with hemophilia type A.

A 34-year-old man with hemophilia type A presented with a huge intracerebral hematoma (ICH) in the left frontoparietal lobe due to rupture of an arteriovenous malformation (AVM). Angiography demonstrated the AVM in the frontoparietal lobe fed by the anterior cerebral arteries and the middle cerebral arteries, with a vein draining into the superior sagittal sinus. He developed signs of cerebral herniation due to the huge ICH. An emergent operation was performed to reduce intracranial pressure and to stop bleeding from the AVM under continuous administration of factor VIII. To prevent postoperative hemorrhage, aggressive blood pressure control and continuous administration of factor VIII were performed for 10 days. His neurological status improved so that he could hold a simple conversation. Continuous administration of factor VIII during surgery and intensive intra- and postoperative therapy resulted in a favorable outcome for this patient with hemophilia type A.