Replies to This Discussion

Permalink Reply by Kuok Cheong U on June 16, 2010 at 9:11pm

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.

Best regard,

Kuok

Permalink Reply by Siba Dalai on June 16, 2010 at 11:42pm

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 .

Opinions invited !!

Regards
Dalai

Permalink Reply by Kuok Cheong U on June 17, 2010 at 6:03am

Possible but high risky procedure.

Permalink Reply by Siba Dalai on June 17, 2010 at 9:05am

how about not doing an embolization?

Patient has not bled.
Its a small AVM.
No weak ares in the nidus or the feeding artery.
Improving symptoms on medication.

R
Dalai

Permalink Reply by Kuok Cheong U on June 17, 2010 at 9:26pm

Hi, Dalai,

will you consider cyber-knife therapy for this case? after all, it seems the nidus is not that big.

Kuok

Permalink Reply by Vasileios Panagiotopoulos on June 17, 2010 at 4:06pm

Hi Siba,

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!

Vasilis