Article Figures & Data
Figures
- Fig 1.
A 47-year-old man with a right parieto-occipital grade 2 AVM discovered incidentally during a work-up for head trauma after a fall. A and B, AP and lateral views of the first diagnostic angiogram. C, Note arterials feeders coming from the MCA, ACA, and PCA, as well as n-BCA from 2 prior embolizations. D, After superselective catheterization of the AVM through a PCA feeder, propofol was injected, causing proximal left-legged weakness. Further embolization was withheld, and the patient was referred for radiosurgery after refusing surgery.
- Fig 2.
A 54-year-old woman with a right medial parietal grade 2 AVM who presented with chronic headaches and dizziness. A and B, AP and lateral views of the first diagnostic angiogram. C, Note prior embolization, which required assistance of aneurysm coils due to the fistulous nature of the lesion. Also note the microcatheterization of the AVM nidus through the ACA feeder. After a superselective Wada test with propofol, the patient showed no neurologic changes, yet after embolization, she developed left-leg distal paresis. D, Postoperative diffusion-weighted MR image shows an ischemic insult close to the embolization area. The patient improved to baseline after physical therapy.
- Fig 3.
A 63-year-old woman with a grade 1 right parietal AVM who presented with left-handed numbness. After discussion of management alternatives, she decided on an endovascular intervention. A and B, AP and lateral views of the diagnostic angiogram. A superselective Wada test with propofol was performed with positive results (embolizable ACA feeder). C, Embolization with n-BCA after placement of the aneurysm coil to slow transit time. D, Note that the follow-up angiogram after 2 months shows no recanalization.
Tables
Demographic and Clinical Parameters Value Age Median (yrs) 52 Range (yrs) 11–76 Sex Male 12 Female 8 Associated conditions HBP 7 DM 3 Hypercholesterolemia 4 CAD 1 Hypothyroidism 1 BA 1 BPH 1 Medications Calcium channel blockers 3 ACE 4 β-blockers 2 α-Agonists 1 AEDs Dilantin (phenytoin) 3 Tegretol (carbamazepine) 1 Levetiracetam 3 Valproic acid 1 Lamotrigine 1 Synthroid (levothyroxine) 1 Statins 4 Other psychiatric/neurologic 4 Clinical presentation Headaches 9 Seizures 4 TIAs 1 Paresthesias 2 ICH, SAH, IVH 4 Dizziness 4 Hemianopsia 1 Incidental 3 Pre-embolization neurologic deficits Blindness 1 Dysarthria 1 Nystagmus 1 Paresis 1 Dysesthesias 1 Hemianopsia 1 Angiographic Parameter Value AVM locations Frontal 3 Parietal 6 Parieto-occipital 4 Temporoparietal 1 Occipital 3 Temporal 2 Cerebellar 1 AVM S-M grades 1 5 2 9 3 5 4 1 Size (cms) ≤1 1 ≤2 and >1 10 ≤3 and >2 13 ≤4 and >3 11 ≤5 and >4 1 ≤6 and >5 0 ≤7 and >6 2 Transit times (secs) 0.5 8 0.75 21 0.83 1 1.0 5 - Table 3:
AVM flow characteristics (in terms of transit times) and the concentration of n-BCAa used with or without aneurysm coils
n-BCAa 0.5 Secs 0.75 Secs 0.83 Secs 1 Sec 50/50 with coils 0 0 0 0 50/50 0 2 0 0 60/40 with coils 4 6 0 1 60/40 0 4 0 1 65/35 with coils 1 1 0 1 65/35 1 3 0 0 70/30 with coils 1 1 0 0 70/30 1 1 1 2 Coils only 0 1 0 0 a Percentage of iodized oil (Lipiodol) over the percentage of n-BCA with or without coils.
