Thalamic Arteriovenous Malformation With an Unusual Draining System

A 52-year-old man suddenly experienced headache and vomiting. Computed tomography demonstrated a small area of hemorrhage in the right cerebellar hemisphere. Angiography revealed a thalamic arteriovenous malformation (AVM) fed by the bilateral medial posterior choroidal arteries and left marginal tentorial artery, and drained into the confluence via the cerebellar veins without flow into the supratentorial venous system. The draining veins included two varices, one of which, in the right cerebellar hemisphere, was thought to be the source of bleeding. The AVM nidus was removed via the right occipital transtentorial approach. A portion of a drainer adhered to the surface of the great vein of Galen but without opening into the galenic system and all drainers from this thalamic AVM flowed into the infratentorial cerebellar venous system.