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

The improved knowledge of clinical and emodynamical aspects of extracranial arteriovenous malformations in the 18 th century provided a foundation for the understanding and treatment of cerebrovascular pathology. It was not until the late 19 th century that detailed clinicopathological reports of intracranial arteriovenous malformations were published. In this historical context, a seminal report written by the Italian surgeon Francesco Rizzoli is worthy of notice, the Giulia case. A 9-year-old girl presenting with seizures and an occipital pulsanting swelling was examined in 1873 by Rizzoli. He was able to use Giulia's signs and symptoms to predict the complex angioarchitecture of her ''arteriovenous aneurysm passing through the wall of skull''. The postmortem dissection completely confirmed the supposed diagnosis, disclosing 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 the current neurosurgical knowledge.