Intracerebral hemorrhage following endovascular embolization of brain arteriovenous malformation with a combination of Onyx and n-butyl cyanoacrylate: a case report

Venous Rupture Following Transcatheter Arterial Embolization for Inferior Mesenteric Type II Arteriovenous Malformation

We treated a 64-year-old man who had an inferior mesenteric arteriovenous malformation with multiple shunts. As multiple varicosities in the draining vein became enlarged, two dilated shunts on the superior rectal and sigmoid colon arteries were coil embolized. Two days after embolization, a varicosity near the shunt (65 mm diameter) ruptured, causing intra-abdominal hemorrhage and surgical hemostasis. There were thrombi in the ruptured varicosity and its draining vein. The likely cause was a pressure increase in the incompletely thrombosed varicosity due to shunt blood flow from the remaining shunts after embolization.

Arteriovenous malformation with associated multiple flow-related distal anterior cerebral artery aneurysms: A case report with poor outcomes

Background

Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder.

Case Description

A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his Glasgow Coma Scale dropped and he underwent emergency embolization with Onyx. This was followed by external ventricular drainage. The patient's neurological status did not improve, and he died following a complicated clinical course.

Conclusion

Multiple DACA aneurysms are a case of both clinical and anatomical rarity and to avoid complications in the clinical course, one must be judicious about the time spent between symptom onset and embolization.

Method for Safely Excising a Large Head and Neck Arteriovenous Malformation in the Hybrid Operating Room

Large head and neck arteriovenous malformations are notoriously difficult to manage given their location and propensity for extreme hemorrhage. We propose a unique approach utilizing a Hyperform balloon and percutaneous Surgiflo sclerotherapy to provide intraoperative hemostatic stability during the excision of a left-sided scalp arteriovenous malformation. In a hybrid operating room a microcatheter balloon was fed into the left external carotid artery for occlusion of the malformation's main blood supply, and subsequently followed with digital subtraction angiography guided sclerotherapy of selective vessels. A split thickness graft was used to reconstruct the site of excision. This method offered optimal hemostatic control with a blood loss less than 120 cc. Our approach may offer safety advantages over traditional modalities and allow resection of head and neck lesions previously thought to be inoperable.