Cerebral arteriovenous malformation

Case contributed by Dr Andrew Lawson

Presentation

Trauma.

Patient Data

Age: 18
Gender: Male
Modality: CT

Noncontrast axial images through the brain have been obtained demonstrating a serpiginous hyperdensity is in the left parietal region.

Modality: CT
A relatively compact arteriovenous malformation is located superficially in the parieto-occipital region on the left, measuring 31 x 18 x 32 mm. It receives most of its supply from the left middle cerebral artery branches, with further contribution from the left posterior cerebral artery. No convincing external carotid supply can be demonstrated. Venous drainage appears predominantly (exclusively?) superficial, with a very large vein coursing posteriorly to drain into the superior sagittal sinus. There is no evidence of haemorrhage or thrombosis or aneurysm formation.
Modality: MRI

Note the presence of flow voids in the AVM.

Modality: DSA (angiography)
An arteriovenous malformation at the junction of left parietal and occipital lobes as a nidus measuring just over 3 cm diameter. Principal blood supply is from enlarged parietal and posterior temporal branches of the left MCA with some contribution from left PCA branches. No right sided supply and no external carotid supply. Venous drainage is via a large vein draining to the superior sagittal sinus and a smaller superficial vein draining to the left sigmoid sinus. No arterial flow related aneurysms. Conclusion: Left parieto occipital AVM ( Spetzler Martin Grade 3).
Large defect in parenchymal phase marks site of resection of the AVM - with no definite AV shunting. Large angular and posterior temporal branches of left MCA - sluggish flow, up to local occlusion of the branches at the level shown previously to contain the AVM. The only area of suspicion for residual nidus was at the anterior margin on the lateral view - with some abnormal vessels, but without definite shunting. No ECA or contralateral supply; the VA-PCA supply has also been removed.

Case Discussion

Satisfactory post-operative resection.

PlayAdd to Share

Case Information

rID: 25619
Case created: 31st Oct 2013
Last edited: 23rd Sep 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.