title: [Transarterial and transvenous embolization of deep binodal arteriovenous malformation of the brain].
abstract: The multimodal approach to treatment of arteriovenous malformations yields good results. However, small and deep malformations still pose a big problem for surgeons. Transvenous embolization was designed as an alternative for the cases when endovascular treatment is required and conventional transarterial embolization is not available.
  
  
  
  A 41-year-old patient with binodal malformation in the subcortical nuclei of the left hemisphere of the brain, which had previously become a source of massive parenchymal ventricular hemorrhage, was operated on using the transarterial and, for the first time in our clinic, transvenous approaches. Transarterial embolization of the thalamic node of malformation was performed as the first step. After 6 months, transvenous embolization of the hypothalamic node of malformations was performed as the second step. Successful operation was ensured by using a stable coaxial guiding catheter system with the maximum distal approach and intranidal positioning of a microcatheter with detachable distal portion upon temporary occlusion of afferent vessels of the malformations using a balloon catheter. The operation resulted in total thrombosis of the malformation. No perioperative complications were observed. Control examination in 6 months did not reveal recanalization of the malformation.
  
  
  
  The transvenous approach can be successfully used in endovascular treatment of small and deep arteriovenous malformations with a single drainage vein, which are inaccessible to direct surgery. It can also be used when radiosurgery is associated with a high risk in cases where transarterial embolization is infeasible.
authors.affiliation: Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
authors.forename: K Yu
authors.initials: KY
authors.lastname: Orlov
authors.affiliation: Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
authors.forename: V V
authors.initials: VV
authors.lastname: Berestov
authors.affiliation: Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia; Novosibirsk State Medical University, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
authors.forename: A L
authors.initials: AL
authors.lastname: Krivoshapkin
authors.affiliation: Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
authors.forename: V A
authors.initials: VA
authors.lastname: Panarin
authors.affiliation: Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
authors.forename: D S
authors.initials: DS
authors.lastname: Kislitsin
authors.affiliation: Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
authors.forename: A V
authors.initials: AV
authors.lastname: Gorbatykh
authors.affiliation: Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
authors.forename: T S
authors.initials: TS
authors.lastname: Shayakhmetov
authors.affiliation: Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
authors.forename: P O
authors.initials: PO
authors.lastname: Seleznev
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D008297:Male