Abstract
A 50-year-old man with an unremarkable medical history except for chronic headaches managed with over-the-counter analgesics was admitted to a local hospital after an episode of unusual persistent headache associated with de novo generalized tonic-clonic seizures. Cranial MRI revealed the presence of a midsized subcortical left temporo-occipital arteriovenous malformation (AVM), Spetzler-Martin grade III. The patient was referred to our center and scheduled for a diagnostic cerebral angiography plus endovascular treatment. Cerebral angiography confirmed that the AVM was supplied by both dural and pial arteries, including the left middle and posterior cerebral artery, left middle meningeal artery, and left occipital artery. A compact plexiform nidus presented multiple intranidal aneurysms and was drained via three cortical veins: one ascending parietal vein to the superior sagittal sinus, one occipital vein to the transverse sinus, and one temporobasal vein to the vein of Labbé. The AVM was treated by endovascular means in a staged manner. During the first two sessions, the main feeders from the left middle cerebral and middle meningeal artery were subsequently catheterized for an embolization with EVOH copolymer (Onyx). A significant reduction of the size and arteriovenous shunt volume had been achieved, leaving a small residual AVM nidus, which was drained through a sole temporobasal vein. A third treatment session was planned for a combined arterial and transvenous approach. Again, Onyx was injected through the left occipital artery. After that, a transvenous embolization through the vein of Labbé allowed occluding the remaining nidus and its draining vein. Follow-up DSA examinations confirmed the persistent occlusion of the AVM. Staged transarterial embolization associated with transvenous embolization to achieve complete occlusion of a complex brain AVM by endovascular means is the main topic of this chapter.
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Veloso, S.N., Lylyk, I., Lylyk, P.N., Lundquist, J., Lylyk, P. (2021). Symptomatic Arteriovenous Malformation (Spetzler-Martin Grade III): Staged Transarterial and Final Transvenous Embolization; Complete Occlusion of the AVM and Excellent Clinical Outcome. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Arteriovenous Malformations and Fistulas Casebook. Springer, Cham. https://doi.org/10.1007/978-3-030-51200-2_32-1
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