The experience of simultaneous endovascular occlusion of arteriovenous malformation and saccular aneurism in a parturient woman
The clinical case of simultaneous endovascular bloodstream exclusion of arteriovenous malformation and saccular aneurysm in parturient woman is presented. Onyx liquid adhesive composition and monospiral aneurysm occlusion technique were used. Patient X., 31, was hospitalized to the clinic on the 10th day of the postpartum period. From the anamnesis: twice (at 20th and 27th weeks of pregnancy) patient suffered intraventricular hemorrhage due to the rupture of arteriovenous malformation in the posterior third of the corpus callosum, left lateral ventricle and left parietal lobe of the brain. After the first hemorrhage a conservative treatment tactic was determined, given the high risk of complications associated with the surgical intervention for the mother and fetus. After the second hemorrhage endovascular embolization of malformation was suggested, however, the patient and her husband refused surgery, preferring conservative therapy with subsequent surgical treatment after delivery. In addition to the malformation, according to the data of selective cerebral subtraction angiography multiple cerebral saccular aneurysms of the left Anterior Cerebral – Anterior Communicating Artery and 2 Anterior Cerebral Artery aneurysms (A2-A2, A3-A4-segments) on the right side were diagnosed. Endovascular subtotal embolization of arteriovenous malformation and occlusion of the right Anterior Cerebral Artery (A2-A3-segment) saccular aneurysm were performed during the operation. A control angiographic examination after 3 months showed a complete exclusion of these arteriovenous malformation and saccular aneurysm and disappearance of all aneurysms of the left Anterior Cerebral Artery – Anterior Communicating Artery and right Anterior Cerebral Artery (A3-A4-segment).
Gross BA, Du R. Natural history of cerebral arteriovenous malformations: a meta-analysis. J. Neurosurg. 2013;118(2):437-43.
Mohr JP, Parides MK, Stapf C et al. Medical ma-nagement with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383: 614-21.
Shheglov D.V. Diagnostyka ta endovaskuljarne likuvannja vnutrishnocherepnyh arterialnyh anevryzm: Avtoref. dys. … d-ra med. nauk. K., 2014:1-2.
Higashida RT. Endovascular treatment of cerebral artery aneurysms during pregnancy: report of three cases. Am J Neuroradiol. 2000;21(7):1306-11.
Lynch JC, Andrade R, Pereira C. Intracranial hemorrhage during pregnancy and puerperium: experience with fifteen сases. Arq Neuropsiquiatr. 2002;60(2-A):264-8.
Skidmore FM, Williams LS, Fradkin KD, Alonso RJ, Biller JJ. Stroke Cerebrovasc. Dis. 2001;10(1):1-10.
Soo Mee Lim, Yong Jae Cho, Lee R. Multiple feeding artery pedicle pseudoaneurysms in the posterior circulation: association with hemorrhage and AVM. Neurointervention. 2011;6(1):27-30. doi: 10.5469.neuroint.2011.6.1.27 PMCID: PMC3214807
Bendjilali N, Nelson J, Weinsheimer S et al. Common variants on 9p21.3 are associated with brain arteriovenous malformations with accompanying arterial aneurysms. J. Neurol. Neurosurg. Psychiatry. 2015;86(5):524-9.
Khaw A, Mohr J, Sciacca R. Association of infratentorial brain arteriovenous malformations with hemorrhage at initial presentation. J. Stroke. 2004;35(3):660-3.
Abdulrauf SI, Malik GM, Awad IA. Spontaneous angiographic obliteration of cerebral arteriovenous malformations. Neurosurgery 1999; 44:280-7.
Krapf H, Siekmann R, Freudenstein D, Kuker W, Skalej M. Spontaneous occlusion of a cerebral arteriovenous malformation: Angiography and MR imaging follow-up and review of the literature. Am J Neuroradiol 2001;22:1556-60.
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