en Functional Neurosurgery Case report <div style="text-align: justify;"><span style="font-family:Times New Roman;"><span style="font-size:12pt"><span style="line-height:200%"><b><span lang="EN" style="font-size:11.0pt"><span style="line-height:200%"><span style="color:black">Background and Importance:</span></span></span></b><span lang="EN" style="font-size:11.0pt"><span style="line-height:200%"><span style="color:black"> Cerebral micro-arteriovenous malformations (micro-AVMs), defined as occult nidus smaller than 1 cm, pose diagnostic challenges on conventional imaging and complicate treatment due to their small size and risk of hemorrhage. Advanced imaging modalities, such as intra-arterial cone-beam computed tomography angiography (CBCT-A), have shown promise in enhancing diagnostic accuracy and treatment planning.</span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:200%"><b><span lang="EN" style="font-size:11.0pt"><span style="line-height:200%"><span style="color:black">Case Presentation</span></span></span></b><span lang="EN" style="font-size:11.0pt"><span style="line-height:200%"><span style="color:black">: We report the case of a 58-year-old woman who presented with intracerebral hemorrhage (ICH) without a history of hypertension. Initial computed tomography (CT) and </span></span></span><span lang="EN" style="font-size:11.0pt"><span style="background:white"><span style="line-height:200%"><span style="color:#1f1f1f">magnetic resonance&nbsp;imaging</span></span></span><span style="line-height:200%"><span style="color:black"> (MRI) failed to identify the underlying vascular anomaly, necessitating catheter-based intra-arterial digital subtraction angiography (DSA), which revealed a small, low-flow nidus indicative of an AVM. Selective CBCT-A provided a detailed angioarchitectural evaluation, enabling precise catheterization and effective nidus occlusion with Onyx 18.</span></span></span></span></span><br> <span style="font-size:12pt"><span lang="EN" style="font-size:11.0pt"><span style="color:black"></span></span></span><span style="font-size:12pt"><span style="line-height:200%"><b><span lang="EN" style="font-size:11.0pt"><span style="line-height:200%"><span style="color:black">Conclusion</span></span></span></b><span lang="EN" style="font-size:11.0pt"><span style="line-height:200%"><span style="color:black">: This case highlights the critical role of combining digital subtraction angiography (DSA) and CBCT-A in the management of AVMs, particularly when traditional imaging is inconclusive. These modalities are crucial for managing AVMs, especially in patients with atypical presentations or those without common cerebrovascular risk factors. </span></span></span></span></span></span><br> &nbsp;</div> Cone-beam computed tomography (CBCT), Intracranial arteriovenous malformations (AVMs), Endovascular procedures 0 0 http://irjns.org/browse.php?a_code=A-10-726-2&slc_lang=en&sid=1 Mohammad Ghorbani mohghorbani@gmail.com 100319475328460012254 100319475328460012254 No Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran. Mohammad Hasanpoor dr.m.hpr@gmail.com 100319475328460012255 100319475328460012255 No Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran. Hojjat Mirsardoo amaf142@gmail.com 100319475328460012256 100319475328460012256 No Hojjat, Department of Neurosurgery, Kerman University of Medical Sciences, Kerman, Iran. Seifollah Jafari jafariseifolla@gmail.com 100319475328460012257 100319475328460012257 No Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Fakhrialsadat Ghasemigeskeminjan fghasemi1992@yahoo.com 100319475328460012258 100319475328460012258 No Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Rouzbeh Shams Amiri rshamsa@gmail.com 100319475328460012259 100319475328460012259 Yes Department of Neurological Surgery, Neuroscience Research Center, Golestan University of Medical Sciences. Gorgan, Iran.