Cerebral Microarteriovenous Malformations: Diagnostic and Therpeutic Features in a Series of Patients
Martino Cellerinia,
Salvatore Mangiaficoa,
Gabriella Villaa,
Marco Nistria,
Cesare Pandolfoa,
Hahman Noubarib,
Franco Ammannatib,
Pasquale Mennonnab,
Antonio Scollatoc,
Paulo Perrinic,
Nicola Di Lorenzoc and
Gian Paolo Giordanoa
a Neuroradiology Unit, University of Florence, Italy
b Neurosurgery Department, Careggi Hospital, University of Florence, Italy
c Neurosurgical Clinic, University of Florence, Italy
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FIG 1. Imaging studies in a 31-year-old man (case 2) with a cortical hematoma in the left angular and supramarginal gyri.
A and B, At admission, lateral early (A) and late (B) arterial-phase angiograms of left internal carotid artery do not show evidence of arteriovenous shunting.
C, Oblique left internal carotid arterial-phase angiogram obtained 1 month later, after hemorrhage resorption, shows early venous filling of two cortical veins that drain in the superior sagittal sinus (arrows and arrowheads).
D, Subsequent superselective exploration of the angular branch of the left middle cerebral artery reveals the feeder, the nidus, and the double superficial venous drainage of the micro-AVM. After stable microcatheter positioning, treatment of the lesion was performed by using a single injection (ie, single shot) of a polymerizing agent.
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FIG 2. Imaging studies in a 43-year-old woman (case 1) with a large hematoma in the left occipitoparietal lobe.
A and B, Frontal (A) and lateral (B) late arterial-phase left vertebral angiograms show a small tangle of arterial blush (curved arrow) and a questionable early venous filling (straight arrow) along the parieto-occipital branches of the left posterior cerebral artery.
C, Superselective exploration of the parieto-occipital branch demonstrates the plexiform structure of the nidus of the micro-AVM, which is characterized by multiple arteriovenous shunts and a single deep draining vein coursing toward the vein of Galen.
D, The lesion could not be embolized because microcatheter tip instability and opacification of functional vessels originated from the distal tract of the feeder. The patient subsequently underwent successful surgery.
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FIG 3. Imaging studies in a 41-year-old man (case 4) with a large hemorrhage of the left paracentral lobule.
A, Oblique arterial-phase left internal carotid angiogram shows early venous drainage in the absence of a clearly defined nidus. Note stenosis of the draining vein at the junction with the superior sagittal sinus (arrow).
B, Superselective exploration of the paracentral branch of the left callosomarginal artery allows identification of the nidus with demonstration of another stenosis (arrow) in the proximal tract of the draining vein.
C and D, After successful embolization, left internal carotid angiograms show the glue cast of the nidus and the draining vein (C) in the absence of any residual arteriovenous shunting (D). C is an arterial-phase oblique view; D, a capillary-phase lateral view.
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