Color Doppler Ultrasound Imaging in the Emergency Management of an Intracerebral Hematoma Caused by Cerebral Arteriovenous Malformations: Technical Case Report

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Abstract
Ruptured arteriovenous malformations (AVMs) are important causes of spontaneous intracerebral hemorrhages. This is a report of emergency hematoma removal, avoiding damage to the nidus of the AVM, using intraoperative color Doppler imaging. A 38-year-old woman suddenly presented with coma. The patient underwent emergency surgery immediately after admission, without preoperative angiographic examination, because of progressive neurological deterioration caused by a massive hematoma in the right basal ganglia, as diagnosed with computed tomographic scanning. A right frontotemporoparietal craniotomy was performed. Intraoperative ultrasound imaging with a color Doppler system (EUP-NS32, 5 MHz; Hitachi Medical, Tokyo, Japan) clearly demonstrated a nidus complex in the hematoma. Based on the imaging, effective decompression of the hematoma was performed without damage to the AVM complex. Color Doppler imaging (with real-time availability) of an atypical hematoma provided significant information on the vascular lesion causing the hematoma and could reduce the surgical risks during emergency evacuation of large intracerebral hemorrhages resulting from ruptured AVMs.