Thalamic Arteriovenous Malformation With an Unusual Draining System-Case Report-

Sato, Taku; Sasaki, Tatsuya; Matsumoto, Masato; Suzuki, Koichi; Satõ, Mitsuo; Sato, Sonomi; Kodama, Namio

doi:10.2176/nmc.44.298

Cited by 5 publications

(11 citation statements)

References 10 publications

(14 reference statements)

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“…Associated stenoses of the outflow made this varix the most vulnerable area of this arteriovenous malformation. There is only one reported case of a similar remote haemorrhage in the cerebellum from a varix in an unusual venous drainage of a thalamic AVM that was treated surgically [16]. The treatment of BAVM is a multidisciplinary task requiring embolisation, surgery and radiosurgery in various combinations.…”

Section: S Chakraborty P Eldridge and H C Nahser E130mentioning

confidence: 99%

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

Chakraborty¹,

Eldridge²,

Nahser³

2010

BJR

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ABSTRACT. The ''spot sign '', described in 2007, has shown that a focal area of contrast extravasation within an intracerebral haematoma (ICH) can be correlated with haematoma expansion. Here we describe a case where time-resolved dynamic CT angiography (dCTA) shows the appearance of the ''spot sign'' only in later images. This shows the importance of timing of static CT angiogram that, if performed too early, might result in a false negative diagnosis. Haemorrhage in patients with intracranial arteriovenous malformation (AVM) usually occurs from the AVM itself or from an associated arterial aneurysm. We report a case of intracerebral haemorrhage arising from a remote varix related to the venous outflow of an ipsilateral frontal AVM. Case reportA 63-year-old male was admitted following a sudden onset of headache associated with neck stiffness and visual disturbances. There was no history of loss of consciousness or focal neurological deficit. On examination, the patient was photophobic and had nuchal rigidity. A visual field test showed a right homonymous hemianopsia but there were no other focal neurological signs.A non-enhanced CT of the brain ( Figure 1a) showed a large left temporal lobe intracerebral haemorrhage with secondary intraventricular and subarachnoid haemorrhage. There was also a calcified lesion in the left frontal lobe (Figure 1b), consistent with calcification within an AVM. A CT angiogram confirmed the presence of a left frontal AVM. An enhancing vascular structure adjacent to the left temporal lobe haematoma (Figure 1c) was demonstrated, representing either a flow aneurysm or a varix. MRI brain (Figure 1d) showed a left temporal intracerebral haematoma with an adjacent spherical area of flow void (Figure 1e), consistent with an aneurysm or varix. An AVM was noted in the left middle frontal gyrus (Figure 1d), distal from the area of haemorrhage. MR angiography (Figure 1f) showed enlarged arterial feeders arising from the left anterior and middle cerebral arteries.The conventional cerebral angiogram (Figure 2) confirmed the presence of a left frontal AVM (SpetzlerMartin grade 1-0-0) that was mainly supplied by branches of the left internal carotid artery. No arterial flow aneurysm was noted. The AVM had a peculiar way of draining. A primary single large collecting vein was divided into several smaller veins, majority of which were draining into the superior sagittal sinus via communication with superficial cortical veins. There was a single vein with a posteroinferior course. During late venous phase, two varices were seen on this vein (Figure 2c, f). Various degrees of stenoses were seen in the peripheral draining veins. The varix, adjacent to the area of haemorrhage, showed impaired outflow because of stenosed segments ( Figure 2f) and was probably the most vulnerable part of this AVM with regard to haemorrhage.During embolisation, the major right prefrontal middle cerebral artery feeder was initially catheterised and the tip of the microcatheter was placed intranidally within the AVM (Figur...

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Section: S Chakraborty P Eldridge and H C Nahser E130mentioning

confidence: 99%

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

Chakraborty¹,

Eldridge²,

Nahser³

2010

BJR

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“…Regarding the possibility of bleeding of these lesions, our experience differs from that reported by other authors since only one patient in our series presented hemorrhage (case 7). In the literature, hemorrhage appears as the clinical presentation in several case reports 4,6–8,15 and in 50% of Wu et al. 16 series.…”

Section: Discussionmentioning

confidence: 99%

“…6 presented a radiosurgery treatment without reporting the outcome; and in 2004, Sato et al. 4 presented a curative surgical treatment. Lawton et al.…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous fistulas of the Vein of Galen region in adults: Endovascular treatment

et al. 2020

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Purpose Arteriovenous fistulas of the Vein of Galen region in adults (Ad-VGAVF) are an uncommon entity with specific anatomic features. The aim of this article is to present our experience in the endovascular treatment of this pathology and to propose a therapeutic strategy based precisely on the angioarchitecture of these lesions. Materials and methods During a 20-year period, 10 patients underwent endovascular treatment of Ad-VGAVF. They were nine men and one woman with a mean age of 50 years (23–66 years) treated with the same embolization strategy. Clinical presentation, angiographic characteristics, therapeutic strategy, and clinical outcomes were recorded. Results All patients were treated exclusively by endovascular approach. Transarterial access was performed in eight patients and combined transvenous and transarterial access in two. Complete obliteration of the fistula was obtained in all patients. There were no intraprocedural complications. Post-embolization neurological symptoms occurred in 5 of 10 with complete resolution at six months in all of them. Conclusion Arteriovenous fistulas of the Vein of Galen region in adults present uniform angioarchitecture despite their low prevalence. Based on this constant angioarchitecture and especially on the features of its venous drainage, judicious embolization strategy is feasible and effective. Ten cases treated entirely by endovascular approach with excellent clinical and angiographic outcomes show this treatment like a curative alternative for this entity of deep topography and severe prognosis.

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“…Usually, thalamic AVMs pose a deep venous drainage, mainly to the vein of Galen or the internal cerebral vein. [16] e TTA is a very rare feeder in cases of AVMs. e number and diameter of the perforating arteries are relatively constant and depend on the size of the PComA.…”

Section: Discussionmentioning

confidence: 99%

Transvenous embolization of a ruptured thalamic arteriovenous malformation supplied by the tuberothalamic artery

Vargas

Saal‐Zapata

Durand-Castro

et al. 2023

Surgical Neurology International

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Background: Basal ganglia and thalamic arteriovenous malformations (AVM) represent 10% of all AVM. They are associated with a high rate of morbidity and mortality due to their high hemorrhagic presentation and eloquence. Radiosurgery has been the first line treatment, whereas surgical removal and endovascular therapy are possible in selected cases. Deep AVM with small niduses and a single draining vein can achieve cure with embolization. Case Description: A 10-year-old boy with sudden headache and vomiting underwent a brain computed tomography scan that showed a right thalamic hematoma. Cerebral angiography revealed a small ruptured right anteromedial thalamic AVM with a single feeder arising from the tuberothalamic artery and a single drainage to the superior thalamic vein. Transvenous approach using precipitating hydrophobic injectable liquid 25%® achieved a complete obliteration of the lesion in a single-session. He was discharged home without neurological sequelae and maintained clinically intact at follow-up. Conclusion: Transvenous embolization of deep-located AVM as a primary treatment is curative in selected cases, with complication rates comparable to other therapeutic strategies.

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Thalamic Arteriovenous Malformation With an Unusual Draining System-Case Report-

Cited by 5 publications

References 10 publications

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

Arteriovenous fistulas of the Vein of Galen region in adults: Endovascular treatment

Transvenous embolization of a ruptured thalamic arteriovenous malformation supplied by the tuberothalamic artery

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