PMC8769487_01
MRA on admission revealed a nidus and a varix in the left parietal lobe (A). T2WI (B) and FLAIR (C) showed a partially thrombosed varix with edema in the postcentral gyrus, but no previous bleeding. FLAIR: fluid-attenuated inversion recovery, MRA: magnetic resonance angiography, T2WI: T2-weighed image.
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F1
Magnetic resonance imaging (MRI) revealed an AVM with a maximum diameter of 34 mm in the left parietal lobe (Fig. 1).
Initial left internal carotid angiograms (lateral view). (A) Arterial phase. (B) Venous phase. (C) 3D rotational angiography. The nidus was fed mainly by the MCA and the varix was located anterior to the nidus. The main feeder from the MCA was occluded just distal to the MCA bifurcation and accompanied with tiny collateral vessels (white arrow). (D) 3D rotational angiography (venous phase) showed enlargement of the varix. A small compartment, the varix neck (asterisk), was located between the varix and a cortical vein draining into the SSS. MCA: middle cerebral artery, SSS: superior sagittal sinus, 3D: three-dimensional.
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F2
Angiography showed that the nidus was fed by the left middle cerebral artery (MCA), the left anterior cerebral artery, and the posterior cerebral artery (Fig. 2). A small compartment with a maximum diameter of 14 mm, a varix neck, was located between the drainer and the varix (Fig. 2).
(A) Left internal carotid angiogram showing insertion of two microcatheters into the varix neck. (B) Coils were tightly packed in the varix neck with the double catheter technique. (C) After coil embolization, blood flow into the varix disappeared.
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F3
After placing 31 coils, blood flow into the varix was eliminated with faint opacification of the varix neck (Fig. 3).
PMC8769487_02
Heavy T2WI before treatment (A), POD6 (B), POM1 (C), POM3 (D), and POM6 (E) showed gradual shrinkage and thrombosis of the varix and improvement of edema in the peri-varix gyrus. T2WI: T2-weighed image.
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F4
Follow-up MRI revealed thrombosis and gradual shrinkage of the varix (Fig. 4).