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Embolization of arteriovenous fistula after radiosurgery for multiple cerebral arteriovenous malformations.
Kaohsiung J Med Sci. 2005 Dec; 21(12):571-7.KJ

Abstract

Cerebral arteriovenous malformation (CAVM) associated with arteriovenous fistula (AVF) is rare. It may be difficult to identify hemodynamic details of mixed CAVM and AVF, even when using x-ray cerebral angiography (digital subtraction angiography). We report on a 37-year-old male patient with headache that led to an initial diagnosis of deep frontotemporal CAVM. The first DSA revealed engorged, tortuous, and high-flow venous drainage in addition to clusters of vasculature niduses. The patient was initially treated using gamma-knife radiosurgery (GKRS), which resulted in partial nidus obliteration, documented by a series of follow-up magnetic resonance imaging (MRI). However, the high-flow venous drainage remained, seen on MRI as engorged venous pouches. Clinically, the patient was bothered by persistent headache and bruits after GKRS. Follow-up DSA 3 years after GKRS confirmed a small remnant CAVM nidus and a nearby AVF, separated from and lateral to the original CAVM nidus in the ipsilateral deep temporal lobe. When the initial DSA was reviewed, it revealed that the AVF was difficult to define because of superimposition of the nidus and engorged drainage vessels. Embolization of the AVF using electrodetachable coils resulted in total occlusion of the AVF. The patient's symptoms resolved immediately after embolization. This case suggests that superselective angiography using a microcatheter may be necessary for the initial diagnosis of CAVM associated with AVF with high-flow and engorged venous drainage. For CAVM patients with persistent symptoms after radiosurgery and engorged venous drainage when CAVM is expected to be cured, a microcatheter and superselective endovascular approach may offer diagnosis. Immediate embolization for associated AVF in the same angiographic session may thereby improve neurologic deficits and reduce hemorrhagic risk during the latency after GKRS.

Authors+Show Affiliations

Luo CB
Department of Radiology, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan. cbluo@vghtpe.gov.tw
Guo WY
No affiliation info available
Teng MM
No affiliation info available
Chang FC
No affiliation info available
Pan DH
No affiliation info available

MeSH

AdultArteriovenous FistulaEmbolization, TherapeuticHumansIntracranial Arteriovenous MalformationsMaleRadiosurgery

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16670050

Citation

Luo, Chao-Bao, et al. "Embolization of Arteriovenous Fistula After Radiosurgery for Multiple Cerebral Arteriovenous Malformations." The Kaohsiung Journal of Medical Sciences, vol. 21, no. 12, 2005, pp. 571-7.
Luo CB, Guo WY, Teng MM, et al. Embolization of arteriovenous fistula after radiosurgery for multiple cerebral arteriovenous malformations. Kaohsiung J Med Sci. 2005;21(12):571-7.
Luo, C. B., Guo, W. Y., Teng, M. M., Chang, F. C., & Pan, D. H. (2005). Embolization of arteriovenous fistula after radiosurgery for multiple cerebral arteriovenous malformations. The Kaohsiung Journal of Medical Sciences, 21(12), 571-7.
Luo CB, et al. Embolization of Arteriovenous Fistula After Radiosurgery for Multiple Cerebral Arteriovenous Malformations. Kaohsiung J Med Sci. 2005;21(12):571-7. PubMed PMID: 16670050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Embolization of arteriovenous fistula after radiosurgery for multiple cerebral arteriovenous malformations. AU - Luo,Chao-Bao, AU - Guo,Wan-Yuo, AU - Teng,Michael M H, AU - Chang,Feng-Chi, AU - Pan,David H, PY - 2006/5/4/pubmed PY - 2006/6/3/medline PY - 2006/5/4/entrez SP - 571 EP - 7 JF - The Kaohsiung journal of medical sciences JO - Kaohsiung J Med Sci VL - 21 IS - 12 N2 - Cerebral arteriovenous malformation (CAVM) associated with arteriovenous fistula (AVF) is rare. It may be difficult to identify hemodynamic details of mixed CAVM and AVF, even when using x-ray cerebral angiography (digital subtraction angiography). We report on a 37-year-old male patient with headache that led to an initial diagnosis of deep frontotemporal CAVM. The first DSA revealed engorged, tortuous, and high-flow venous drainage in addition to clusters of vasculature niduses. The patient was initially treated using gamma-knife radiosurgery (GKRS), which resulted in partial nidus obliteration, documented by a series of follow-up magnetic resonance imaging (MRI). However, the high-flow venous drainage remained, seen on MRI as engorged venous pouches. Clinically, the patient was bothered by persistent headache and bruits after GKRS. Follow-up DSA 3 years after GKRS confirmed a small remnant CAVM nidus and a nearby AVF, separated from and lateral to the original CAVM nidus in the ipsilateral deep temporal lobe. When the initial DSA was reviewed, it revealed that the AVF was difficult to define because of superimposition of the nidus and engorged drainage vessels. Embolization of the AVF using electrodetachable coils resulted in total occlusion of the AVF. The patient's symptoms resolved immediately after embolization. This case suggests that superselective angiography using a microcatheter may be necessary for the initial diagnosis of CAVM associated with AVF with high-flow and engorged venous drainage. For CAVM patients with persistent symptoms after radiosurgery and engorged venous drainage when CAVM is expected to be cured, a microcatheter and superselective endovascular approach may offer diagnosis. Immediate embolization for associated AVF in the same angiographic session may thereby improve neurologic deficits and reduce hemorrhagic risk during the latency after GKRS. SN - 1607-551X UR - https://www.unboundmedicine.com/medline/citation/16670050/Embolization_of_arteriovenous_fistula_after_radiosurgery_for_multiple_cerebral_arteriovenous_malformations_ DB - PRIME DP - Unbound Medicine ER -