Stable course of a giant cerebral arteriovenous malformation during pregnancy: A case report

Abstract

Cerebral arteriovenous malformations (AVMs) are rare vascular anomalies that pose significant challenges during pregnancy due to the risk of intracranial hemorrhage and lack of clear management guidelines. Management depends on individualized decision-making and a multidisciplinary approach. We report the case of a 32-year-old G3P1L1A1 with a long-standing cerebral AVM in the right parieto-temporo-occipital lobe with midline shift diagnosed in 2011, 
who presented during pregnancy with headache at 29 weeks of gestation but without neurological deficits. Magnetic resonance imaging revealed an AVM of 9.4 × 6.6 × 4.2 cm with multiple arterial feeders and deep venous drainage via the vein of Galen and midline shift. She was managed conservatively with multidisciplinary monitoring throughout pregnancy. She underwent elective cesarean section at 37 weeks of gestation, delivering a healthy baby. The patient remained stable in the postpartum period without requiring neurosurgical intervention. This case highlights that even high-grade AVMs with mass effect may remain stable during pregnancy, supporting individualized and conservative management in selected patients.