A 20-year-old female presented with sudden severe headaches. Computed tomography showed an intraventricular hemorrhage and slightly dilated lateral ventricles. Her neurological examinations revealed no abnormalities. Magnetic resonance (MR) images and cerebral angiography revealed arteriovenous malformation (AVM) in the right parietal lobe. The size of the nidus was 1.8 cm, and it was located in the deep white matter. It was fed by middle cerebral arteries and drained by the vein of Galen. Diffusion tensor tractography (DTT) demonstrated that the right pyramidal tract was situated close to the nidus. The AVM was surgically resected completely, without any complications, using intraoperative neuronavigation image guidance. Neuronavigation images combined with DTT are useful for surgical resection of AVM that is located close to the pyramidal tract.
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