Francesco Rizzoli (1809-1880) and the elusive case of Giulia: the description of an "arteriovenous aneurysm passing through the wall of the skull"

The improved knowledge of the clinical and haemodynamical aspects of extracranial arteriovenous malformations in the 18th century provided a foundation for the understanding and treatment of cerebrovascular pathology. It was not until the late 19th century that detailed clinicopathological reports of intracranial arteriovenous malformations were published. A seminal report by the Italian surgeon Francesco Rizzoli described Giulia, a 9-year-old girl who presented with seizures and an occipital pulsanting swelling in 1873. Rizzoli used Giulia's signs and symptoms to predict the complex angioarchitecture of her "arteriovenous aneurysm passing through the wall of skull". Postmortem examination confirmed the supposed diagnosis, and showed a direct communication between the hypertrophic branches of the ocipital artery and the transverse sinus. The clinical course of that case is briefly reviewed in this article and the diagnosis of this unusual arteriovenous shunt is discussed in light of current neurosurgical knowledge.