PMC10227433_01
Cervicothoracic MRI. Sagittal cervicothoracic MRI T2-weighted images revealed longitudinal swelling of the medulla oblongata and cervicothoracic spinal cord extending to T6 level (A, C), with apparent abnormal flow void signals in the anterior surface of the cervical spinal cord (A). Contrasted MRI showed anterior and posterior perimedullary dilated tortuous veins from the cervical to T12 level (B, D), apparent enhancement in cervical spinal anterior horns on both sides (arrows) (E), and patchy enhancement in the whole cervicothoracic spinal cord (B, D).
fneur-14-1128366-g0001.jpg
PMC10227433_01_fneur-14-1128366-g0001.jpg
F1
Magnetic resonance imaging (MRI) revealed extensive longitudinal swelling of the medulla oblongata and cervicothoracic spinal cord with enlarged abnormal perimedullary tortuous vessels and notable enhancement in bilateral cervical anterior gray matter (Figures 1A-E). MRI follow-up showed a marked decrease in T2 hyperintensity in the spinal cord as well as the resolution of the abnormal perimedullary flow voids (Supplementary Figures 1A, B). AVM (Supplementary Videos 3, 4). An MRI follow-up 9 months after the procedure showed a complete disappearance of T2 hyperintensity in the cervical spinal cord (Supplementary Figure 1C).
Brain CTA. Source images of brain CTA showed a large abnormal vessel (arrowhead) connecting to a vascular cluster close to the inferior horn of the left lateral ventricle (short arrow). The left posterior cerebral artery was also disclosed (long arrow) (A). Volume reconstruction of CTA revealed the supplied artery and drainage veins of the micro-AVM on the choroidal fissure (B). anterior choroidal artery, AchA; inferior ventricular vein, IVV; basal vein of Rosenthal, BA; lateral mesencephalic vein, LMV; superior petrosal vein, SPV; middle cerebellar peduncle vein, MCPV; anterior and posterior spinal veins, A/PSV; internal auditory canal, IAC.
fneur-14-1128366-g0002.jpg
PMC10227433_01_fneur-14-1128366-g0002.jpg
F2
Source images of the brain CT angiogram showed a large abnormal vessel connected to a vascular cluster adjacent to the inferior horn of the left lateral ventricle (Figure 2A). 3D volume reconstructing images of brain CT angiogram (Figure 2B) and cerebrospinal angiography (Figures 3A, B) showed a micro-AVM on the choroidal fissure close to the left cerebral ventricular wall, which was supplied by the left anterior choroidal artery and drained exclusively by an inferior ventricular vein, connecting to the basal vein of Rosenthal, the lateral mesencephalic vein, the superior petrosal vein, then the middle cerebellar peduncle vein, and finally the anterior and posterior spinal veins, descending toward lower thoracic spinal cord (Supplementary Videos 1, 2).
Cerebral angiography indicated a micro-AVM (arrow) supplied by the left anterior choroidal artery branch, which drained downward through a sole large vein into the anterior and posterior spinal veins (A, B). After the endovascular embolization of the AVM, the draining veins completely disappeared (C).
fneur-14-1128366-g0003.jpg
PMC10227433_01_fneur-14-1128366-g0003.jpg
F3
Source images of the brain CT angiogram showed a large abnormal vessel connected to a vascular cluster adjacent to the inferior horn of the left lateral ventricle (Figure 2A). 3D volume reconstructing images of brain CT angiogram (Figure 2B) and cerebrospinal angiography (Figures 3A, B) showed a micro-AVM on the choroidal fissure close to the left cerebral ventricular wall, which was supplied by the left anterior choroidal artery and drained exclusively by an inferior ventricular vein, connecting to the basal vein of Rosenthal, the lateral mesencephalic vein, the superior petrosal vein, then the middle cerebellar peduncle vein, and finally the anterior and posterior spinal veins, descending toward lower thoracic spinal cord (Supplementary Videos 1, 2). The feeding pedicle, nidus, and proximal segment of the draining vein were completely obliterated (Figure 3C).