PMC4533335_01
A 50-year-old male with a ruptured AVM (Spetzler-Martin grade III). A: DSA (lateral view, right internal carotid angiography) shows the nidus (arrow) and main feeding artery from the right anterior cerebral artery. B: Injection of Eudragit-E is clearly visible with fluoroscopy. C: Postoperative CT image (axial view) shows the cast of Eudragit-E (arrow) with minimal artifacts. D: Postoperative T2-weighted MRI (axial view) reveals the Eudragit-E cast (arrow) and residual nidus (N). E: Postoperative DSA image (lateral view) after two sessions of endovascular embolization and gamma knife radiosurgery shows no residual AVM. AVM: arteriovenous malformation, CT: computed tomography, DSA: digital subtraction angiography, MRI: magnetic resonance imaging.
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F1
MRI and DSA revealed that the AVM was located in the right corpus callosum (Fig. 1A). Eudragit-E was injected into the nidus and was clearly visualized with fluoroscopy (Fig. 1B). Postoperative CT and MRI showed the Eudragit-E cast and residual AVM (Fig. 1C, D). Postoperative DSA (Fig. 1E) and MRI revealed complete obliteration of the AVM.
PMC4533335_02
A 16-year-old female with an intracerebral hemorrhage from a ruptured AVM (Spetzler-Martin grade II). A: DSA (lateral view, left internal carotid angiography) reveals the nidus (arrow) with feeders from the left angular artery. B: Injection of Eudragit-E is clearly visible with fluoroscopy. C: Postoperative DSA (lateral view) shows no residual AVM. D: Follow-up DSA performed 6 months later reveals the recurrence of AVM (arrow). E: Blood vessels that were embolized with Eudragit-E (arrow) are elastic and whitish in color. AVM: arteriovenous malformation, CT: computed tomography, DSA: digital subtraction angiography.
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F2
The nidus was approximately 17 mm in diameter with feeders from the left angular artery and drainers into cortical veins (Fig. 2A). Endovascular embolization using Eudragit-E was performed without complications (Fig. 2B). No residual AVM was observed with DSA at the end of the endovascular procedure (Fig. 2C). However, follow-up MRI and DSA performed approximately 6 months later revealed recurrence of the AVM (Fig. 2D). Intraoperative findings showed that the vessels and nidus that had been embolized with Eudragit-E were elastic and whitish in color (Fig. 2E).