This 25-year-old female presented with a single episode of seizure. An MRI (not shown) demonstrated a subependymal parenchymal (pial) arteriovenous malformation. This cerebral angiogram was performed for further assessment and for radiotherapy planning.
The left vertebral artery injection, lateral view (left) demonstrates a deep nidus supplied by branches of the basilar artery. The right internal carotid artery injection, lateral view (right) shows supply to more anterior portions of the nidus from branches of the middle cerebral artery. Drainage is to dilated deep veins, including internal cerebral veins, vein of Galen, and straight sinus. The partially-subtracted dots visible on the images are from the stereotactic planning frame, and allow exact 3D localisation of the nidus. There was no evidence of aneurysm or stenoses either on arterial or venous sides of the lesion.
This lesion is moderate size (3-6cm), has deep venous drainage, and is situated in an eloquent area, making it a Spetzler grade IV.
Management options for arteriovenous malformations include surgical resection, endovascular occlusion, stereotactic radiation, or a combination. Preoperative embolisation is frequently used to reduce intraoperative blood loss. Radiotherapy is usually reserved for cases with a low risk of haemorrhage during the treatment period (up to 2 years).
Reference: Osborn AG. Diagnostic Neuroradiology Mosby. 1994.
Credit: Dr Jason WenderothCredit: Dr Laughlin Dawes