[Arteriovenous malformation resembling galenic aneurysm].
A girl who had just turned one year old was transported to our hospital because of an episode of general convulsive seizure. Neurological examinations demonstrated a comatose consciousness level, moderate right hemiparesis and conjugate deviation to the right. CT scan on admission revealed an intracerebral hematoma in the left medial temporal lobe associated with intraventricular hemorrhage in the lateral and third ventricles. MRI also showed the hematoma with evidence of a dilated venous system. Angiography demonstrated a huge venous sac fed by the left posterior choroidal artery and left anterior choroidal artery drained ultimately into the remnant of the tentorial sinus. Firstly, two courses of transfemoral embolization using platinum micro-coils were performed. Initially, the posterior choroidal artery and a branch of the anterior choroidal artery were occluded successfully. Then, two branches from the posterior cerebral artery were occluded one week after the initial procedure. She underwent the operation via the left subtemporal approach. After the CSF removal through the Sylvian fissure, the gentle elevation of the left temporal lobe allowed the visualization of the feeders and the pulsating venous sac. After the complete obliteration of the feeding arteries and removal of the nidus, the interruption was verified by using doppler sonography and intraoperative angiography. Postoperative course was uneventful. The infant was discharged without deficit on the 30th postoperative day. The authors discussed the embryological implications of this type of AVM and the role of endovascular surgery.
Anegawa
S
S
Department of Neurosurgery, St. Mary's Hospital.
Hayashi
T
T
Torigoe
R
R
Utsunomiya
H
H
Ogasawara
T
T
Goto
K
K
D002550:Cerebral Veins; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000175:diagnosis*; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy