PMC5234292_01
(a) Noncontrast computed tomography (CT) scan demonstrating left putaminal hemorrhage. White arrow indicates slightly high dense round mass adjacent to the falx cerebri. (b) Raw image of CT angiography demonstrating that the round mass was well enhanced with contrast medium (black arrow)
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F1
On computed tomography, a left putaminal hematoma and smooth round masses in the anterior part of the interhemispheric fissure were found [Figure 1a]. Computed tomography angiography also revealed an AV shunt in the anterior part of the falx cerebri and the round mass was identified as a dilated bridging vein that drained the shunt [Figure 1b].
(a, b) Anteroposterior views of right (a) and left (b) external carotid arteries showing an arteriovenous fistula fed with bilateral middle meningeal arteries. (c, d): Lateral views of the right external (c) and internal carotid (d) arteries showing an arteriovenous fistula in the falx cerebri. (e) Image showing embolization of the shunt performed with a mixture of 12.5% n-butyl cyanoacrylate and lipiodol. (f, g): Lateral views of the right external (f) and internal (g) carotid arteries on 3-month control angiography showing a complete obliteration of the arteriovenous fistula
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F2
Selective angiography revealed an AV shunt located in the falx cerebri that was supplied by the anterior branch of the bilateral middle meningeal artery [Figure 2a-c] and right dural branch of the middle internal frontal arteries [Figure 2d]. Warmed, highly diluted glue (12.5% n-BCA diluted using ethiodized oil) was injected to fill the shunt, with penetration into the pathological venous segment including the venous ectasia [Figure 2e]. Control digital subtraction angiography performed 3 months after the operation revealed complete occlusion of the AVF [Figure 2f and g].