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Fig 5. Occipital AVM before and after treatment.
A, Frontal right vertebral angiogram demonstrates a small, high-flow, parieto-occipital AVM with an enlarged feeder supplying 2 intranidal fistulas (arrows) before embolization.
B and C, Same projection after partial embolization. Glue can be seen at the site of the fistulas, and the venous drainage remained patent.
D, DSA, performed 6 weeks later (same projection) in conjunction with and before an additional embolization. A spontaneous occlusion of the feeder supplying the fistula is noted with a partial reduction of the nidus. The vein is still patent but reduced in size.
E–P, Axial T2-weighted, DWI, ADC maps, and rCBF done after the first embolization (E–H), before (I–L), and after (M–P) the second treatment. A vasogenic edema (black arrow) evolved in between the treatments, because of a spontaneous thrombosis of the feeder, nidus plus draining vein (white arrow), and decreased immediately after the second embolization. A small, perinidal ischemic lesion is seen after the last treatment (arrowhead). The patient experienced minor and transient headaches in between the embolizations.
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