- School of Medicine, Georgetown University, Washington, DC 20057, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
DOI:10.4103/2152-7806.166174Copyright: © 2015 Braileanu M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Braileanu M, Yang W, Caplan JM, Huang J. Imaging the spontaneous obliteration of a cerebral arteriovenous malformation using c-arm cone beam computed tomography: A case report. Surg Neurol Int 28-Sep-2015;6:
How to cite this URL: Braileanu M, Yang W, Caplan JM, Huang J. Imaging the spontaneous obliteration of a cerebral arteriovenous malformation using c-arm cone beam computed tomography: A case report. Surg Neurol Int 28-Sep-2015;6:. Available from: http://surgicalneurologyint.com/surgicalint_articles/imaging-the-spontaneous-obliteration-of-a-cerebral-arteriovenous/
Background:Spontaneous occlusion of a cerebral arteriovenous malformation (AVM) without treatment is a rare occurrence.
Case Description:We report the case of a 56-year-old male who presented with aphasia and right hemiparesis secondary to intracerebral and intraventricular hemorrhage. Diagnostic digital subtraction angiography (DSA) and c-arm cone beam computed tomography (CBCT) demonstrated a 5 mm Spetzler-Martin Grade III left thalamic AVM drained by the internal cerebral vein. Subsequent DSA and CBCT studies confirmed the spontaneous obliteration of the AVM.
Conclusions:In this case, CBCT provided high resolution imaging of the AVM. Future clinical use of CBCT as an adjunct to DSA may enhance the diagnostic and therapeutic imaging of vascular lesions.
Keywords: Arteriovenous malformation, c-arm cone beam computed tomography, digital subtraction angiography
The spontaneous occlusion of an intracranial arteriovenous malformation (AVM) without treatment occurs rarely, with an estimated incidence of 0.5–1.3%.[
Digital subtraction angiography (DSA) is currently considered the gold-standard imaging modality for characterizing AVMs. Recently, c-arm cone beam computed tomography (CBCT) has emerged as a clinically useful technology in producing cross-sectional images of AVMs.[
A 56-year-old male initially presented with aphasia and right hemiparesis. Head CT, and brain magnetic resonance imaging (MRI) revealed a left thalamic intracerebral hemorrhage with intraventricular extension [
The arteriovenous malformation (AVM) nidus (arrowhead), seen on lateral digital subtraction angiography (a, b and c) and three-dimensional sagittal (d) and coronal (e and f) cone beam computed tomography reconstructions (left carotid injections), is fed by the left anterior choroidal artery (hollow arrow) and a thalamic perforator branch of the left posterior communicating artery (right vertebral injection, not shown), and drained by the left internal cerebral vein (solid arrow). (a) Hematoma obscures the nidus at presentation, (b, d and e) 3 months follow-up reveals the AVM, and (c and f) 7 months follow-up demonstrates complete spontaneous AVM obliteration
Diagnostic DSA and CBCT performed 3 months after presentation demonstrated a Spetzler-Martin Grade III left thalamic AVM [Figure
Six months after presentation, MRI and MRA performed for SRS planning did not demonstrate the AVM, or the previously seen flow enhancement of the thalamus on MRA. Seven months after initial presentation, DSA and CBCT confirmed the spontaneous angiographic resolution of the AVM [Figure
Spontaneous AVM obliteration is a rare, but not unheard of, phenomenon.[
To our knowledge, we report the first case imaged with both DSA and CBCT. Although DSA is considered the gold standard of diagnostic AVM imaging, the modality is at times limited. At initial presentation, the described AVM nidus could not be visualized on DSA due to concurrent hematoma [
The use of CBCT also facilitates simultaneous identification of feeding arteries and draining veins. Distinguishing the draining vein as the internal cerebral vein from the superficial middle cerebral vein is challenging on DSA due to overlapping vasculature at presentation and diagnosis [Figure
Patients with complete spontaneous AVM regression should be closely monitored as angiographic obliteration is not always indicative of good outcomes. Future routine use of CBCT as an adjunct to DSA for the diagnosis and follow-up of AVMs may be clinically valuable, particularly for very small AVMs.
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