15 year old male presented with the following symptoms for 15 days 1.headache 2.slight bulging of the left eye 3. one episode of vomiting MR suggests a brainstem AVM. Angiogram shows an AVM Kindly opine on the mode of treatment for this boy.
Challenging case, what are you going to do next? will you perform further selective angiography? will you consider Onyx procedure? I saw your video clip for another case, that was nice! Please let me know what is your decision and final result of this case, thanks.
i think, there is very little arterial segment to come back for an onyx injection from arterial side.
I am thinking of going from the venous route with Onyx injection, Onyx-34 to form a plug and than
retrograde push of Onyx-18 into the nidus.
Reason: 1. No suitable arterial access 2. Single draining vein .
the case seems very challenging and difficult to treat. I think that VM is symptomatic and needs treatment sooner or later. I would perform microangiography and possibly treat Glubran if possible. I see many tiny feeders difficult to embolize but you never know! I use mainly Onyx but i think it is not idicated in this case. My neurosurgical experience says that if you occlude inittially the single draining vein of an AVM (neurosurgically or endovascular ) it will explode. Neverthelless some interventionists like Prf Moret in Paris have described the retrogade method. Good luck . Please let us know!