case_images: PMC9443662_01
case_images: Digital subtraction angiography left internal carotid artery (ICA) demonstrated the left basal ganglia arteriovenous malformation in case 1 (A). Superselective arteriography and embolization via the anterior choroidal artery (B). Immediate angiography of left ICA after transarterial embolization showed a residual small nidus (C). TVE was performed due to the lack of optimal arterial access. Dual microcatheters (black arrows) were positioned in the origin of the venous collector and a balloon microcatheter (white arrow) was placed in the ipsilateral internal carotid artery (D). After the balloon was inflated to provisionally occlude the internal carotid artery, we used the PCT to occlude the nidus (E). Digital subtraction angiography 4 months later confirmed AVM obliteration (F).
case_images: fneur-13-813207-g0001.jpg
case_images: PMC9443662_01_fneur-13-813207-g0001.jpg
case_images: F1
case_images: Nidus size was 1.98 cm and venous drainage was deep (Figure 1A). AChA and Glubran  (GEM SRL, Viareggio, Italy) was injected into the nidus under fluoroscopic guidance (Figure 1B). Afterward, DSA showed a Glubran  cast and a smaller nidus volume (Figure 1C). Two microcatheters were positioned through the straight sinus within the origin of the venous collector, and a balloon microcatheter was placed in the ipsilateral internal carotid artery (Figure 1D). After the balloon was inflated to provisionally occlude the internal carotid artery, we used the typical transvenous PCT to occlude the nidus completely (Figure 1E). AVM obliteration (Figure 1F). At the 4-month follow-up, the patient was asymptomatic with an mRS score of 0.
case_images: PMC9443662_02
case_images: Digital subtraction angiography demonstrates the right basal ganglia arteriovenous malformation in case 2 (A). Superselective arteriography and embolization via the posterior communicating artery (B). Angiography after transarterial embolization shows a partially embolized arteriovenous malformation (C). TVE was performed due to the lack of optimal arterial access. Transvenous microcatheter injection angiography confirmed an optimal position of the microcatheter tip (D). After the balloon (white arrow) was inflated to provisionally occlude the ipsilateral internal carotid artery, Onyx was injected transvenously into the AVM nidus through the microcatheter, and ~2 cm of embolysate reflux (black arrow) was encountered prior to achieving sufficient retrograde nidal penetration (E). Postoperative angiography showed complete embolization (F). However, postoperative CT confirmed intracranial hemorrhage (G). Angiography 1 year later showed complete embolization of the arteriovenous malformation (H).
case_images: fneur-13-813207-g0002.jpg
case_images: PMC9443662_02_fneur-13-813207-g0002.jpg
case_images: F2
case_images: Nidus size was 2.56 cm and venous drainage was deep (Figure 2A). During the first stage procedure, superselective arteriography demonstrates the AVM angioarchitecture (Figure 2B). Glubran  was injected via the PCA, and DSA after the first stage shows the partially embolized AVM (Figure 2C). Two microcatheters were positioned at the origin of the venous collector, microangiography was then performed to better visualize the angioarchitecture of draining veins and adjust the position of the microcatheter tip (Figure 2D). After the balloon was inflated to provisionally occlude the internal carotid artery, Onyx was injected transvenously into the AVM nidus through the microcatheter, and ~2 cm of embolysate reflux (black arrow) was encountered prior to achieving sufficient retrograde nidal penetration (Figure 2E). The final DSA showed complete obliteration of the AVM (Figure 2F). Unfortunately, the child awoke with difficulty from anesthesia, Dyna CT showed AVM hemorrhage (Figure 2G). One year later, DSA confirmed complete AVM obliteration and mRS score was 2 (Figure 2H).
case_images: PMC9443662_03
case_images: A right internal carotid artery (ICA) angiogram, anteroposterior projection (A) and lateral projection (B), demonstrating a Spetzler-Martin grade III brain arteriovenous malformation (BAVM) located in the right basal ganglia drained by the basal vein of Rosenthal, the nidus was supplied by the right AChA and LSAs. After provisional balloon occlusion of theright ICA, Onyx was injected transvenously into the AVM nidus and sufficient retrograde nidal penetration was achieved (C). The Onyx cast is visualized at the end of the procedure (D). Final angiography of right ICA, anteroposterior projection (E) and lateral projection (F), showed complete obliteration of BAVM.
case_images: fneur-13-813207-g0003.jpg
case_images: PMC9443662_03_fneur-13-813207-g0003.jpg
case_images: F3
case_images: Nidus size was 2.24 cm and venous drainage was deep (Figures 3A,B). AChA and LSAs. After provisional balloon occlusion of the ICA, the PCT was successfully used (Figures 3C,D). Final DSA confirmed complete obliteration of the AVM (Figures 3E,F).
case_images: PMC9443662_04
case_images: Digital subtraction angiography of left internal carotid artery (ICA) after incomplete nidus resection and hematoma evacuation shows the left temporal arteriovenous malformation in case 4 (A). Superselective arteriography and embolization via the temporal branches of the middle cerebral artery (B). Immediate angiography of left ICA after transarterial embolization showed a residual small nidus (C). TVE was performed due to the lack of optimal arterial access. Superselective arteriography confirmed an optimal position of the microcatheter tip (D), Onyx was injected transvenously into the AVM nidus through microcatheter. Final angiography of left ICA, anteroposterior projection (E) and lateral projection (F) confirmed complete obliteration.
case_images: fneur-13-813207-g0004.jpg
case_images: PMC9443662_04_fneur-13-813207-g0004.jpg
case_images: F4
case_images: Nidus size was 0.79 cm and venous drainage was superficial (Figure 4A). The patient underwent conventional transarterial embolization via the temporal branches of the MCA using Onyx 18  (Figure 4B). Postembolization DSA showed a residual nidus (Figure 4C). A microcatheter was positioned at the origin of the venous collector, microangiography was then performed to better observe the angioarchitecture of draining veins and adjust the position of the microcatheter tip (Figure 4D). Onyx 18  was injected transvenously into the AVM nidus through a microcatheter until anatomic obliteration of the AVM (Figure 4E). DSA confirmed complete AVM obliteration (Figure 4F).