Cerebral Arteriovenous Malformation Cases from the General University Hospital of Alicante

Cerebral Arteriovenous Malformation Headache of 2 days of evolution. The pain is right frontoparietal, throbbing, and does not improve with analgesia. usual and that has come to wake him up at night. The night before admission, she was associated with vomiting.

In the CT right parietotemporal lobar hemorrhage of about 40x46x31mm in their approximate APxTxCC axes with perilesional hypointense halo due to edema and clot retraction and mild mass effect collapsing the ipsilateral ventricular atrium without deviation significant from the midline (about 2mm to the left).

A purely pial temporal posterior-parietal arteriovenous malformation with a 20×12 mm nidus is observed, with a 4 x 2 mm intranidal flow aneurysm in the cranial portion of the nidus. The aneurysm is in the distal part of the nidus. Very small arterial feeders of temporal branches of the right MCA. Single venous drainage through a superficial cortical vein to the right transverse sinus.

A 31-year-old man with a cerebral arteriovenous malformation in the deep and medial aspect of the right cerebral hemisphere, whose arterial contributions are established through the branches of the anterior choroidal artery and posterior choroidal arteryes, lenticulostriate arteries and perforating thalamus, whose venous drainage is through the right internal cerebral vein that reaches the vein of Galen and other medial venous branches that reach the superior sagittal sinus. The malformation nest has diameters of approximately 30 x 50mm.

After developing hydrocephalus he was operated on with ventriculoperitoneal shunt + endoscopic septostomy. Ventriculoperitoneal shunt infection removal of the infected hardware and ventriculoatrial shunt placement

7 years later he presents with a headache of two days of evolution in the frontal area that does not subside with paracetamol, associated with nausea with dizziness, and appreciating a BP of 140/90 mmHg, for which reason he has taken 50 mg captopril on his own and comments that it has made him sick with nausea.

Post-surgical changes after insertion of a ventriculoatrial shunt catheter through the right frontal trephine, with the distal end of the catheter not appearing to reach the anterior horn of the right lateral ventricle. Already known large right frontotemporal arteriovenous malformation, with an imprint of the drainage vein on the interventricular septum deviated to the left, and with dilatation of the vein of Galen that has not changed with respect to the previous control. Its drainage vein is ectatic and empties into the vein of Galen, without significant changes. There are no signs of intracranial hemorrhage or signs of established acute ischemia. Diffuse increase in ventricular size with respect to MRI, this increase being very evident in relation to the parietal and temporal horns, probably related to progressive hydrocephalus from Cerebrospinal fluid shunt malfunction.

Pedicled horseshoe incision at basal left occipital. A trephine is made and inserted with a DVE navigator in the left occipital horn about 6cm with a high-pressure CSF outlet. A short distance from the same incision, obstruction of the previous proximal EVD is checked and a new connection is made at the level of the previous valve. The old catheter was left tied (because it did not pull the previous EVD very close to the AVM).