Perisylvian Arteriovenous Malformation Mimicking Carotid Cavernous Fistula: Operative Video

Brain arteriovenous malformations (AVM) commonly present for medical attention after a patient experiences a rupture that results in a focal neurologic deficit, an epileptic event, or is found incidentally on cranial imaging performed for an unrelated reason. In contrast, carotid-cavernous fistulas (CCF) can develop high-flow arteriovenous shunting with symptoms attributable to venous hypertension. We discuss a unique case of a 54-year-old female presenting with signs and symptoms suggestive of a CCF but was found to have a perisylvian AVM with an enlarged draining vein draining into the cavernous sinus. Our case report demonstrates a combined endovascular and open surgical approach to a unique presentation of a brain AVM with the resolution of ocular symptoms.