case_images: PMC9800803_01
case_images: DSA at baseline and at 6 months' follow-up. (A,B) Sagittal angiogram showing coil embolization of a ruptured PComA on the right side. (C) Coil embolization of the unruptured AComA aneurysm at 6 months' follow-up without missing sings of PComA reperfusion (both MRRC, class II).
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case_images: PMC9800803_01_fsurg-09-860416-g001.jpg
case_images: F1
case_images: The three-dimensional digital subtraction angiography (3D-DSA) further demonstrated a 4 mm anterior communicating artery aneurysm (AComA) that filled arteriographically from the right side (Figure 1).
case_images: Early, middle, and late phases of DSA. (A-C) Sagittal (lateral) and (D-F) coronal (anterior-posterior) angiograms (views) demonstrating the adjacent flow-related MCA aneurysms on the left side with the associated BAVM. Note the presence of the BAVM venous ectasia in the later phase (C,F).
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case_images: PMC9800803_01_fsurg-09-860416-g002.jpg
case_images: F2
case_images: In addition, we encountered a left postcentral gyral neopallial BAVM (Supplemented Spetzler-Martin, SSM, grade 5; namely size 1 point, venous drainage 0 points, eloquence 0 points, age 3 points, bleeding 1 point, compactness 0 points), with two large distal flow-related aneurysms of the middle cerebral artery (MCA) on the M2 segment (20 mm) and the M3 segment (8 mm), (Figure 2) respectively.
case_images: TWIST MR angiography before and after BAVM elimination. (A-C) Axial, coronal, and sagittal TWIST (time-resolved angiography with interleaved stochastic trajectories) MR angiography depicting both flow-related MCA aneurysms and associated BAVM. (D-F) Complete regression of the flow-related MCA aneurysms following the encounter of BAVM elimination.
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case_images: PMC9800803_01_fsurg-09-860416-g003.jpg
case_images: F3
case_images: Onyx (Medtronic, Minneapolis, United States) using a transarterial approach, and then surgically extirpated. Both indocyanine green and intraoperative 3D-DSA revealed complete elimination of the BAVM, along with early regression of both flow-related MCA aneurysms (Figures 3, 4). One-year follow-up was uneventful, with no evidence of reperfusion of the flow-related MCA aneurysms on MR angiography.
case_images: Intraoperative angiogram after BAVM elimination. (A,B) Coronal and sagittal angiogram depicting regression of the flow-related MCA aneurysms following the encounter of BAVM elimination.
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case_images: PMC9800803_01_fsurg-09-860416-g004.jpg
case_images: F4
case_images: Onyx (Medtronic, Minneapolis, United States) using a transarterial approach, and then surgically extirpated. Both indocyanine green and intraoperative 3D-DSA revealed complete elimination of the BAVM, along with early regression of both flow-related MCA aneurysms (Figures 3, 4). One-year follow-up was uneventful, with no evidence of reperfusion of the flow-related MCA aneurysms on MR angiography.