Development of a huge varix following endovascular embolization for cerebellar arteriovenous malformation

Abstract

We report on the case of a huge varix that developed after the endovascular embolization of a cerebellar arteriovenous malformation (AVM) with a single drainer. A 21-year-old male presented with trigeminal neuralgia which was caused by the dilated drainer of the AVM. A varix was found at the basal vein of Rosenthal 2 months after an initial stage of embolization with polyvinyl alcohol particles; it diminished after the surgical extirpation of the AVM. The varix formation might have been facilitated by the stenosis in the vein of Galen and by the dynamic changes that followed the embolization. This rare complication should be kept in mind when embolization is performed for AVMs with impaired venous outlets.

Trigeminal neuralgia caused by brain arteriovenous malformations: A case report and literature review

“…Among the 40 patients evaluated ( 4 , 12 , 14 – 40 ), there were 27 patients ( 4 , 12 , 15 , 19 , 21 , 24 – 29 , 31 , 34 – 40 ) in whom TGN was demonstrated to originate from vascular compression as determined by angiography or during the surgical procedure. Of these 27 patients, TGN was caused by compression by the feeding arteries of bAVMs (n=8)( 4 , 15 , 24 , 28 , 29 , 35 , 38 , 39 ), the draining venous system (n=4)( 19 , 26 , 37 , 40 ), malformation niduses (n=5)( 12 , 27 , 38 ), simultaneous compression by the feeding arteries and the draining venous system (n=3)( 21 , 34 , 38 ), simultaneous compression by the feeding arteries and the malformation niduses (n=1)( 36 ), the simultaneous compression by the draining venous system and the malformation niduses (n=5)( 25 , 31 ) and simultaneous compression by the feeding arteries, the draining venous system and the malformation niduses (n=1) ( 25 ). Since the origin of vascular compression could not be confirmed by image analysis in certain patients, and these patients had also received drug therapy, interventional embolization, and destructive neurosurgical manipulation of the TG nerve, the incidence of TGN originating from vascular compression may be even higher.…”

“…In addition, the craniotomy for resection of bAVMs may also confirm whether the feeding arteries and the draining veins compress the TG nerve root; if necessary, MVD can be performed simultaneously ( 44 ). Among the 40 patients evaluated ( 4 , 12 , 14 – 40 ), 42.5% of the patients received surgical resection (n=17), and amongst these 17 patients ( 19 , 23 , 25 – 32 , 34 , 35 ), 11 patients received surgical resection alone ( 19 , 25 , 27 – 30 , 32 ), 3 patients received surgical resection combined with MVD ( 25 , 34 , 35 ), and 2 patients received surgical resection due to complications following embolization ( 23 , 26 ), and 1 patient received surgical resection due poor effect after destructive neurosurgical manipulation of the TG nerve ( 31 ). The pain caused by TGN was immediately relieved in all the patients who received surgical resection.…”

“…Excluding two patients for whom the information was incomplete ( 27 , 33 ), there were 24 male and 14 female patients (male:female ratio, ~1.71) aged between 23 and 69 years with a mean age of 46.8±14.7 years. These patients presented with bAVMs located in the CPA (n=19)( 12 , 16 , 17 , 20 , 23 , 27 – 33 , 36 , 38 ), cerebellar hemisphere (n=8)( 15 , 18 , 21 , 26 , 34 , 35 , 40 ), the TG nerve (n=7)( 22 , 25 , 39 ), the cerebellar vermis (n=3)( 4 , 14 , 24 ), the pontine (n=1)( 37 ), the septum pellucidum (n=1)( 19 ) and both the cerebellar hemisphere and cerebellar vermis (n=1)( 38 ) ( Fig. 3 ).…”

“…In terms of treatment, 2 patients received drug therapy ( 17 ) and 1 patient was without mention of treatment ( 12 ). The other 37 patients received non-drug treatment ( 4 , 14 – 40 ), 11 patients received surgical resection alone ( 19 , 25 , 27 – 30 , 32 ), 2 patients received surgical resection following partial embolization ( 23 , 26 ), 1 patient received surgical resection following destructive neurosurgical manipulation of the TG nerve( 31 ), 3 patients received surgical resection of bAVMs combined with microvascular decompression (MVD; 14,15,18,20,24), 5 patients received an interventional embolization treatment, 2 patients received radiotherapy following embolization ( 4 , 21 ), 6 patients received MVD treatment alone ( 37 – 39 ), 2 patients received radiotherapy following MVD ( 36 , 40 ), 4 patients received destructive neurosurgical manipulation of the TG nerve ( 16 , 17 , 33 , 38 ), and 1 patient received stereotactic radiotherapy (SRS; 22) ( Fig. 4 ).…”

Arteriovenous Malformation Surrounding the Trigeminal Nerve-Case Report-

“…5,7,14,15) Moreover, the close relationship between cranial nerves and symptomatic AVMs usually results in nerve paresis. 4,5,7,10,[12][13][14][15]18,22) We describe a case of trigeminal nerve AVM that manifested as subarachnoid hemorrhage (SAH) without preceding symptoms.…”