Fleisher Max S, Patrick Hayes H, Najera Edinson, Jean Walter C
Department of Neurosurgery, George Washington University, Washington, DC.
Department of Neurosurgery, Lehigh Valley Hospital Network, Allentown, Pennsylvania.
J Neurosurg Case Lessons. 2025 Apr 28;9(17). doi: 10.3171/CASE24850.
The authors discuss the first reported case of a large, high-grade arteriovenous malformation (AVM) in the dominant hemisphere, discovered incidentally after a penetrating nail gun injury.
The patient underwent surgical removal of a nail lodged in the right frontal lobe. A contralateral AVM was diagnosed on his perioperative imaging and was evaluated further with diagnostic cerebral angiography. Because of the location of the AVM within the dominant fronto-opercular region, the patient underwent a super-selective Wada test to evaluate for the risk of expressive language deficit prior to undergoing a successful resection of the AVM. He had an excellent recovery from both surgeries without any neurological deficits.
This case illustrates the importance of continued suspicion for incidental findings when reviewing imaging, despite the presence of a known and obvious pathology. The observations add nuance to the standard considerations for surgical intervention for penetrating nail gun injuries, and the workup for incidentally found vascular lesions is reviewed. https://thejns.org/doi/10.3171/CASE24850.
作者讨论了首例报告的位于优势半球的大型、高级别动静脉畸形（AVM）病例，该病例是在穿透性射钉枪损伤后偶然发现的。
患者接受了手术取出嵌入右额叶的钉子。在围手术期成像中诊断出对侧AVM，并通过诊断性脑血管造影进一步评估。由于AVM位于优势额-岛叶区域，患者在成功切除AVM之前接受了超选择性Wada试验，以评估表达性语言缺陷的风险。他从两次手术中均恢复良好，无任何神经功能缺损。
该病例说明了在复查影像时，尽管存在已知且明显的病变，但仍需持续怀疑偶然发现的重要性。这些观察结果为穿透性射钉枪损伤的手术干预标准考量增加了细微差别，并对偶然发现的血管病变的检查进行了回顾。https://thejns.org/doi/10.3171/CASE24850
