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FIG 1. Illustrative patient 1.
A, Anteroposterior (AP) view of the right dorsocervical artery obtained before embolization shows a large AVM involving C5-C7 and supplied by the ASA.
B, AP right dorsocervical angiogram obtained after second embolization shows decreased opacification of the nidus with preservation of the anterior spinal axis (arrowheads) with one remaining indirect feeder (arrows).
C, AP right dorsocervical angiogram obtained 11 months after second embolization at the time of third embolization shows spontaneous occlusion of the anterior spinal axis (arrowhead) and the remaining indirect feeder (arrow). Note the decreased caliber of the ASA proximally and the increased diameter of the indirect supply. Compare with B.
D, AP superselective ASA angiogram from just before the origin of the feeder shows complete occlusion of the anterior spinal axis distal to this origin. Arrowhead indicates the microcatheter tip in the anterior spinal axis. Arrows indicate the remaining feeder. Because provocative test results were negative, we embolized the malformation from this position with NBCA; symptoms did not worsen.
E, AP right vertebral angiogram after third embolization. ASA is opacified from above, with minimal supply to the remaining nidus (arrowhead) mainly supplied by the vertebral artery branch. There is slow flow in the radiculomedullary artery from the right dorsocervical artery (arrow), which reaches the level of embolization in a later phase (not shown).
F, Schematic illustration of the AVM in relation to the spinal cord. A indicates vertebral artery; B, radiculomedullary artery from the dorsocervical artery; C, ASA; D, feeders embolized in the first two procedures; E, feeder embolized in the third procedure; F, AVM nidus; and G, ASA segment occluded in the third embolization.
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