PMC3262997_01
(a, b) Head CT showing a right occipital intraparenchymal hemorrhage with extension into the right lateral and fourth ventricle
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F1
An urgent computerized tomography (CT) scan revealed a right occipital intraparenchymal hematoma with intraventricular extension into the right lateral and fourth ventricle [Figure 1].
MRI with axial T1WI (a), axial T2WI (b) and sagittal T1WI (c) images, obtained 3 months after hemorrhage, showing resorption of the hematoma and residual encephalomalacia in the right occipital lobe
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F2
Three months following the hemorrhage, on November 16, 1995, she underwent a brain Magnetic Resonance Imaging (MRI) that showed an area of encephalomalacia in the right occipital lobe [Figure 2].
Anteroposterior (AP, a) and lateral (b) right internal carotid artery angiogram, performed 4 months after hemorrhage, showing a right occipital Spetzler-Martin grade III arteriovenous malformation (4 x 3 x 1.5 cm) with feeders from the posterior parietal and angular branches of the middle cerebral artery and early superficial cortical venous drainage to the right transverse sinus. There were no feeders arising from the external carotid artery or vertebro-basilar system
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F3
A subsequent DSA was performed on December 28, 1995, which revealed a Spetzler-Martin grade III (4 x 3 x 1.5 cm) occipital AVM supplied by the posterior parietal and angular branches of the middle cerebral artery (MCA) and draining through a superficial cortical vein into the right transverse sinus [Figure 3].
AP (a) and lateral (b) right common carotid artery angiogram, performed 17 days after surgery, showing no residual arteriovenous malformation
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F4
Postoperative DSA performed 17 days after surgery demonstrated no residual AVM [Figure 4].
CTA (a) with axial reconstruction (b), obtained 16 years after arteriovenous malformation (AVM) resection, showing recurrence of the AVM in the anterior portion of the resection cavity in the right occipital lobe
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F5
CT angiography revealed a recurrence of the right occipital AVM fed by MCA branches and draining into the superior sagittal sinus (SSS) [Figure 5].
AP (a) and lateral (b) right common carotid artery angiogram showing recurrence of a Spetzler-Martin grade III (3 x 3.5 x 3.5 cm) arteriovenous malformation with middle cerebral artery branch feeders and drainage through a cortical vein to the SSS. Postoperative angiography (c) shows complete resection
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F6
The patient was referred to our center where, on August 24, 2011, a DSA confirmed the right occipital AVM [Figure 6a and b]. Postoperative DSA performed 7 days after surgery showed no evidence of residual AVM [Figure 6c].