case_images: PMC10481525_01
case_images: Anteroposterior (A), lateral (B), and oblique (C) projections of a preoperative digital subtraction angiography (DSA) from a right internal carotid artery injection demonstrated a diffuse right frontal arteriovenous malformation (AVM), with feeders from the right anterior cerebral artery and deep venous drainage. Preoperative head CT (D) shows an intraparenchymal hematoma centered in the right medial frontal lobe extending to the callosal sulcus.
case_images: fneur-14-1165155-g001.jpg
case_images: PMC10481525_01_fneur-14-1165155-g001.jpg
case_images: fig1
case_images: The CTA confirmed the presence of a right medial frontal diffuse AVM (13.40 x 12.60 x 18.82 mm), with feeders from the right anterior cerebral artery, deep venous drainage, and an associated small perinidal aneurysm (Figure 1).
case_images: Intraoperative images showing planning and completion of the transvenous Onyx embolization of the diffuse right frontal arteriovenous malformation (AVM). Balloon test occlusion of the anterior cerebral artery A1 segment (A) was done during embolization for proximal vascular control of the AVM nidus flow. After superselective venous catheterization of the straight sinus, deep venous system, and right frontal AVM nidus, superselective runs (B) showed nidus configuration and no significant collateral reflux. Unsubstracted radiograph (C) shows proper placement of aneurysm coil proximal to the nidus performed under fluoroscopic guidance to reduce venous reflux of Onyx (pressure cooker technique). Oblique digital subtraction angiography (DSA) view of right internal carotid injection post-embolization (D) showed complete obliteration of the AVM nidus.
case_images: fneur-14-1165155-g002.jpg
case_images: PMC10481525_01_fneur-14-1165155-g002.jpg
case_images: fig2
case_images: Complete obliteration of the arteriovenous defect was confirmed with a post-procedure angiogram (Figure 2).
case_images: Lateral (A,B) and oblique (C) projections of control digital subtraction angiography (DSA) 10 months after embolization showing no evidence of arteriovenous malformation (AVM) recurrence.
case_images: fneur-14-1165155-g003.jpg
case_images: PMC10481525_01_fneur-14-1165155-g003.jpg
case_images: fig3
case_images: Ten months after the procedure, the patient presented to the neurosurgery clinics for a follow up angiogram, revealing no evidence of AVM recurrence (Figure 3).