Introduction
A brain arteriovenous malformation (AVM) is a tangle of blood vessels that connects arteries and veins in the brain. Some people with a brain AVM experience signs and symptoms, such as headaches or seizures. An AVM is often found during a brain scan for another health issue or after the blood vessels rupture and bleed (hemorrhage). Once diagnosed, a brain AVM must be treated if it bleeds or causes symptoms.
Brain arteriovenous malformations are frequently associated with the presence of intracranial aneurysms. These intracranial aneurysms can be very small and challenging which may confer a higher risk of hemorrhage at presentation or re-hemorrhage if untreated properly.
Aneurysms and aneurysm-like dilations can be divided in reference to the AVM nidus into extranidal and intranidal. Extranidal aneurysms are located on the wall of feeding arteries (arterial aneurysms) or on draining veins (venous varices) proximal (pre-nidal) and distal (post-nidal) to the AVM nidus, respectively. Intranidal aneurysms are, by definition, located within the boundaries of the nidus and are angiographically opacified before substantial venous filling has occurred.
Case Presentation and History
A very interesting case was performed in one of the major cities in Egypt, Tanta, situated in the middle of the Nile Delta, 100 km from Cairo, the capital. This is where our latest ARTIS zee system installed in 2022, supported Dr. Hazem Abd El Khalek to handle this complex and challenging case.
Professor Hazem, with his long-standing experience across many years on different interventional systems, expressed his utmost satisfaction with the excellent 3D images produced on the ARTIS Zee system which proved to be incredibly valuable and reliable enabling him to successfully conclude this critical challenging case.
The case was for a 32-year-old female patient, presenting with right-side weakness and mild dysphasia. CT Brain scan showed left parietal hematoma with small AVM. Carotid angiogram was done with a previous 3D reconstruction, but the cause of bleeding could not be identified.
Case Management
The case was then scheduled for intervention with Prof. Hazem on our latest ARTIS Zee with Pure. Carotid angiogram was done first showing left parietal AVM as depicted in the images.
By using the Dyna 3D tool, the intranidal small aneurysm responsible for the bleeding was clear. The procedure was implemented with femoral approach and Fargomax 6F reaching the left carotid. Angio was done where the AVM was found arising from middle/anterior cerebral arteries. 3D imaging revealed intranidal aneurysm. Sonic 1.2 microcatheter over hybrid 0.07 microwire was used to navigate through the anterior cerebral artery superior parietal branch then onyx embolization with occlusion of the aneurysm and complete cure of the AVM without complications.
Case follow-up showed the patient clear from symptoms.
Conclusion
Even in cases that would seem straightforward, missing crucial details could lead to unfinished jobs and that makes all the difference in reaching the best possible results. Powerful 3D tools producing superb image quality make a difference in case management and results.
Siemens Healthineers Advanced Therapies is all about providing the patient and the physician the best experience possible.
Contact
Tanta University, Egypt