Delayed hemorrhagic complication after complete embolization of a brain arteriovenous malformation

Endovascular embolization is an essential therapeutic approach in the multidisciplinary management of cerebral arteriovenous malformations (AVM). However, it rarely occludes the AVM in its entirety. It is often combined with surgery or stereotactic radiosurgery. The aim of embolization is to reduce...

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Bibliographic Details
Published in:Neuro-chirurgie 2018-09, Vol.64 (4), p.316-320
Main Authors: Sy, E.C.N., Melot, A., Troude, L., Al-Falasi, M., Brunel, H., Roche, P.-H.
Format: Article
Language:English
Subjects:
Arteriovenous malformation
Brain - blood supply
Brain - surgery
Embolization
Embolization, Therapeutic - methods
Hemorrhage - diagnosis
Hemorrhage - etiology
Hemorrhage - surgery
Humans
Intracerebral hemorrhage
Intracranial Arteriovenous Malformations - complications
Intracranial Arteriovenous Malformations - diagnosis
Intracranial Arteriovenous Malformations - surgery
Male
Microsurgery
Middle Aged
Radiosurgery - methods
Retrospective Studies
Treatment Outcome
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Summary:Endovascular embolization is an essential therapeutic approach in the multidisciplinary management of cerebral arteriovenous malformations (AVM). However, it rarely occludes the AVM in its entirety. It is often combined with surgery or stereotactic radiosurgery. The aim of embolization is to reduce the size of the nidus and the intra-nidal flow in order to facilitate the microsurgical or the radiosurgical procedure. We report the case of a 61-year-old patient with a right frontal hemorrhagic AVM treated with complete embolization in a single session. Initially, a surgical procedure for excision of the AVM was scheduled 24hours post-embolization. This surgery was canceled due to a good angiographic result of the embolization. Eight days post-embolization, there was a massive re-bleed of the AVM which justified emergency surgical management. This case illustrates a delayed post-embolization hemorrhagic complication of an occluded AVM and prompts a review of the therapeutic strategy of the cerebral AVM to select the most effective and least morbid procedure or combination of procedures.
ISSN:0028-3770
1773-0619
DOI:10.1016/j.neuchi.2018.04.005