PMC4533427_01
Lateral views of pre-embolization [early arterial phase (a) and late arterial phase (b)] and those of post-embolization [early arterial phase (c) and late arterial phase (d)]. The flow of nidus was remarkably decreased (c, d) after embolization.
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F1
Magnetic resonance imaging (MRI) showed a vermis AVM, which was subsequently confirmed by catheter angiography (Figs. 1a, b, 2a, b). The patient elected to have endovascular embolization for AVM. The AVM was partially embolized and TGN was partially relieved though the patient suffered from temporary truncal ataxia after embolization (Figs. 1c, d, 2c, d).
Frontal views of pre-embolization [early arterial phase (a) and late arterial phase (b)] and those of post-embolization [early arterial phase (c) and late arterial phase (d)]. The flow of nidus was remarkably decreased (c, d) after embolization.
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F2
Magnetic resonance imaging (MRI) showed a vermis AVM, which was subsequently confirmed by catheter angiography (Figs. 1a, b, 2a, b). The patient elected to have endovascular embolization for AVM. The AVM was partially embolized and TGN was partially relieved though the patient suffered from temporary truncal ataxia after embolization (Figs. 1c, d, 2c, d).
Axial T2-weighted magnetic resonance images before embolization [a, b (a little upper slice)] and after embolization and gamma knife radiosurgery (GKRS) (c), 6 years after GKRS (c). The dilated left superior cerebellar artery compressed and bent the left trigeminal nerve before both treatment (a, b). It was normalized in thickness and did not deform the nerve, though it contacted the nerve after embolization and GKRS (c).
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F3
Compression around the root entry zone of the left trigeminal nerve by dilated left SCA was also detected (Fig. 3a, b). MRI showed remarkable reduction of the abnormal vessels around the nidus and improvement of the dilation of the left SCA (Figs. 3c, 5, 6).
Axial magnetic resonance images of three-dimensional spoiled gradient recalled echo with gadolineum enhancement (a) showed residual nidus and persistent dilation in the left superior cerebellar artery. Only whole the nidus volume (5.4 ml) was treated with gamma knife radiosurgery with a margin dose of 20 Gy. The isodose curve of 20 Gy is shown in axial (b), sagittal (c), and coronal plane (d) for dose planning.
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F4
One month later subsequent GKRS was performed at the residual nidus (Fig. 4).
T2-weighted axial magnetic resonance images at a: pre-embolization, b: post-embolization (pre-GKRS), and c: 6 years after GKRS. Flow void of the abnormal vessels (a) was decreased after embolization (b) and then disappeared after GKRS (c) (arrows). The flow void of the left superior cerebellar artery was getting thinner after embolization and GKRS in a stepwise manner (arrow heads). GKRS: gamma knife radiosurgery.
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F5
MRI showed remarkable reduction of the abnormal vessels around the nidus and improvement of the dilation of the left SCA (Figs. 3c, 5, 6).
Basal views of magnetic resonance angiography at a: pre-embolization, b: post-embolization (pre-GKRS), and c: 6 years after GKRS. The dilated left superior cerebellar artery (a) has normalized after embolization and GKRS in a stepwise fashion. GKRS: gamma knife radiosurgery.
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F6
MRI showed remarkable reduction of the abnormal vessels around the nidus and improvement of the dilation of the left SCA (Figs. 3c, 5, 6).