PMC9990770_01
(a) Non-contrast brain computed tomography (CT) scan at admission showed a bleeding in the right anteromedial thalamus (arrow) and intraventricular hemorrhage. (b) Contrast-enhanced CT scan showed no evidence of abnormal enhancement in the right thalamus (arrow). (c) Before embolization, non-contrast CT scan showed encephalomalacia in the anteromedial portion of the right thalamus (arrow) with slight ventricular enlargement.
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F1
CT scan was performed but was not conclusive to detect a vascular pathology [Figure 1]. Clinically, he was alert, without motor or sensitive impairment.
(a and b) Right internal carotid artery angiography in frontal and lateral views showing a thalamic micro-arteriovenous malformations (AVM) nidus (arrow). Road-mapping of the posterior communicating artery (large arrow) shows the feeding artery arising from the right tuberothalamic artery (empty arrow), the AVM nidus with an intranidal aneurysm (arrowhead) and the draining vein that is the superior thalamic vein (small arrow) in frontal (c) and lateral views (d). Superselective angiography of the right tuberothalamic artery (empty arrow), showing the AVM nidus (arrow head) and the superior thalamic vein (arrow) in frontal (e) and lateral views (f).
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F2
Digital subtraction angiography showed a ruptured right thalamic AVM with a maximal diameter of 3.9 mm, with a single feeder arising from the right TTA, an intranidal aneurysm and a single draining vein to the right superior thalamic vein and internal cerebral vein [Figure 2].
Ruptured right anteromedial thalamic arteriovenous malformations (AVM) supplied by the tuberothalamic artery, the AVM nidus with intranidal aneurysms (arrow head) and the right superior thalamic vein. The venous and arterial microcatheters are indicated, as well as their distal ends. (a) Superselective angiography performed through the right superior thalamic vein in lateral view. (b) Road-mapping in lateral view. (c and d) Fluoroscopic view showing the cast of precipitating hydrophobic injectable liquid 25% (dotted circle) in frontal and lateral views.
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F3
Once in the correct position, precipitating hydrophobic injectable liquid (PHIL 25%; Microvention, Tustin, CA, USA) was injected manually during a period of 10 min and a total obliteration of the nidus was achieved [Figure 3].
Six-month angiographic follow-up. (a) Right internal carotid artery (ICA) in frontal view demonstrates the absence of the arteriovenous malformations nidus (dotted circle). (b) Right ICA in lateral view shows a complete obliteration of the nidus (dotted circle). (c) Non-enhanced brain computed tomography shows the embolization material in the anteromedial part of the right thalamus (arrow).
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F4
Immediate brain CT scan was done and no bleeding was detected [Figure 4].