PMC10196381_01
Preoperative brain CT images show a right temporal lobe cerebral hemorrhage and a diffuse subarachnoid hemorrhage, suggesting an Arteriovenous Malformation (AVM).
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Computed tomography angiography (CTA) of the brain revealed cerebral hemorrhage in the right temporal lobe and diffuse subarachnoid hemorrhage, raising the possibility of an arteriovenous malformation (AVM) (Figure 1).
Before surgery, a right internal carotid cerebral angiography revealed an 8.9 x 7.4 mm vascular malformation in the right temporal lobe, which is fed by the ipsilateral middle cerebral artery's inferior trunk branch (A-C). The MMA was free of aneurysms (D). The surgical images show a blood clot and a distorted vascular mass in the insular cortex (E, F).
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Intraoperatively, an 8.9 x 7.4 mm vascular malformation in the right temporal lobe, which was fed by the inferior trunk branch of the ipsilateral middle cerebral artery, was discovered on right internal carotid cerebral angiography (Figures 2A-C) (Supplementary Video S1). No aneurysm was observed in the right MMA during this time (Figure 2D). Surgical footage showed a blood clot and a distorted vascular mass in the insular cortex (Figures 2E, F).
A full resection of a cerebral vascular abnormality was identified during the evaluation (A, B). In the cerebral angiography following surgery, a 3.3 x 3.1 mm aneurysm of the right posterior MMA was discovered at the craniotomy cut edge of the skull (C, F). Angiograms demonstrating late filling of a MMA aneurysm and contrast medium stagnation (D, E).
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B); however, a 3.3 x 3.1 mm posterior right MMA aneurysm (Figure 3C) (Supplementary Videos S2, S3) was seen, which was absent on initial cerebral angiography. Because angiography demonstrated late filling of the aneurysmal sac during the arterial phase and contrast medium stagnation, this MMA aneurysm was classified as a pseudoaneurysm (Figures 3D, E). The aneurysm was visible near the cut edge of the skull in the images (Figure 3F).
The ONYX 18 embolic agent was injected into the right MMA posterior branch (A). There was no evidence of an aneurysm or the posterior branch of the right MMA (B). It's the timeline of the patient receiving treatment and follow up (C).
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A 5 ml ONYX 18 embolic agent was progressively injected through a microcatheter into the posterior branch of the MMA (Figure 4). Here is the timeline of the patient receiving treatment and follow up (Figure 4C).