PMC10247219_01
T2-weighted magnetic resonance imaging (A) shows dilated and tortuous vessels in the right cerebellomedullary cistern. The varix (arrow) is observed behind the medulla oblongata. Anterioposterior view (B) and lateral view (C) of the right vertebral angiogram revealed pial arteriovenous fistula. Arrowheads indicate the early filling of veins, and double arrows indicate feeders branched from the vertebral artery and posterior inferior cerebellar artery. Axial views of slab MIP images (D and E) of the right vertebral angiogram show the detailed structure of the lesion. Note that vessels are distinguishable from each other and that it is easy to chase their connections. Double arrowheads indicate the right posterior inferior cerebellar artery.
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Dizziness improved spontaneously, but MRI showed a cluster of dilated vessels occupying the right cerebellomedullary cistern (Fig. 1a). Six-vessel cerebral angiography revealed a high-flow arteriovenous shunt within the right cerebellomedullary cistern (Fig. 1b-e).
Anterioposterior view (A) and lateral view (B) of the right vertebral angiogram immediately after coil embolization. The right vertebral angiogram 9 months after treatment (C and D) showed no residual sunt. Note that the origins of each feeder (arrows in A and B) are no longer shown in C and D. Fluid attenuated inversion recovery images 3 months after treatment (E and F) show obstructed varix and veins (arrows).
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G: A simplified schematic drawing of the angioarchitecture. The open arrow indicates the fistula. The sites trapped by coils are also depicted. IJV, internal jugular vein; PICA, posterior inferior cerebellar artery; SPS, superior petrosal sinus; VA, vertebral artery
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The follow-up angiography performed 9 months after treatment showed no residual shunt (Fig. 2).