PMC9800803_01
DSA at baseline and at 6 months' follow-up. (A,B) Sagittal angiogram showing coil embolization of a ruptured PComA on the right side. (C) Coil embolization of the unruptured AComA aneurysm at 6 months' follow-up without missing sings of PComA reperfusion (both MRRC, class II).
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The three-dimensional digital subtraction angiography (3D-DSA) further demonstrated a 4 mm anterior communicating artery aneurysm (AComA) that filled arteriographically from the right side (Figure 1).
Early, middle, and late phases of DSA. (A-C) Sagittal (lateral) and (D-F) coronal (anterior-posterior) angiograms (views) demonstrating the adjacent flow-related MCA aneurysms on the left side with the associated BAVM. Note the presence of the BAVM venous ectasia in the later phase (C,F).
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In addition, we encountered a left postcentral gyral neopallial BAVM (Supplemented Spetzler-Martin, SSM, grade 5; namely size 1 point, venous drainage 0 points, eloquence 0 points, age 3 points, bleeding 1 point, compactness 0 points), with two large distal flow-related aneurysms of the middle cerebral artery (MCA) on the M2 segment (20 mm) and the M3 segment (8 mm), (Figure 2) respectively.
TWIST MR angiography before and after BAVM elimination. (A-C) Axial, coronal, and sagittal TWIST (time-resolved angiography with interleaved stochastic trajectories) MR angiography depicting both flow-related MCA aneurysms and associated BAVM. (D-F) Complete regression of the flow-related MCA aneurysms following the encounter of BAVM elimination.
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Onyx (Medtronic, Minneapolis, United States) using a transarterial approach, and then surgically extirpated. Both indocyanine green and intraoperative 3D-DSA revealed complete elimination of the BAVM, along with early regression of both flow-related MCA aneurysms (Figures 3, 4). One-year follow-up was uneventful, with no evidence of reperfusion of the flow-related MCA aneurysms on MR angiography.
Intraoperative angiogram after BAVM elimination. (A,B) Coronal and sagittal angiogram depicting regression of the flow-related MCA aneurysms following the encounter of BAVM elimination.
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Onyx (Medtronic, Minneapolis, United States) using a transarterial approach, and then surgically extirpated. Both indocyanine green and intraoperative 3D-DSA revealed complete elimination of the BAVM, along with early regression of both flow-related MCA aneurysms (Figures 3, 4). One-year follow-up was uneventful, with no evidence of reperfusion of the flow-related MCA aneurysms on MR angiography.