PMC8645473_01
Pre-surgical cerebral angiography of the vertebro-basilar circulation (2013) in anteroposterior (a and b) and lateral projections (c and d) showiing AVM of the posterior circulation supplied by branches of the left posterior cerebral artery in its P4 segment with deep venous drainage to the basal vein of Rosenthal.
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F1
AVM rupture in 2013. A 2013 angiography revealed a left occipital lobe AVM, fed by the calcarine and the posterior inferior temporal artery branches, with superficial venous drainage through the medial occipital vein into the posterior third of the superior sagittal sinus, and deep drainage through the occipital vein into the vein of Galen, thus classifying it as a Spetzler-Martin grade III AVM [Figure 1].
Cerebral angiography of the vertebro-basilar circulation prior to 2019 surgery in anteroposterior (a-c) and lateral projections (d-f) In early to late angiographic phases respectively where residual AVM and intraluminal embolization material are observed. Anteroposterior (g) and lateral projections (h) showing the route of the intraluminal catheter from the right jugular foramen to the posterior third of the superior sagittal sinus is observed (white arrow).
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F2
He was reinvestigated using cerebral angiography, which demonstrated residual AVM with the embolization material and the presence of an endovenous catheter in the posterior third of the superior sagittal sinus up to the right jugular vein [Figure 2].
Brain magnetic resonance imaging in sagittal slices where intra-axial image is observed in the left precuneus. T1 with gadolinium (a) and T2 (b).
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F3
T2, located in the convexity of the left pre-cuneus, surrounded by significant perilesional edema. The lesion showed significant ring enhancement with the passage of the contrast medium [Figure 3].
Right cervical region of the patient shows perilesional erythema and exudate through the surgical wound (a), as well as surgical images, with the extraction of the endovenous catheter and resection of surrounding granuloma (b and c).
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F4
We opened the jugular vein to remove the catheter and subsequently ligated the vein [Figure 4].
Post-surgical control magnetic resonance imaging in axial sections, weighted in T1 with gadolinium (a), T2 (b) and FLAIR (c), observing postsurgical changes without residual lesion. Post-surgical control cerebral angiography of the vertebro-basilar circulation in anteroposterior (d-f) and lateral projections (g-i) in early to late angiographic phases respectively where without evidence of residual AVM is observed.
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F5
Cerebral angiography revealed the absence of residual AVMs [Figure 5].