Medi-Fax Atlas Series - Left Temporal AVM

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Atlas of Brain - Aneurysm and Other Vascular Anomalies

Editor: Dr. Chris Ekong

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Left Temporal AVM

Contributor:

Dr. Chris Ekong

Consultants:

Dr. Renn Holness
Dr. Mike Tymianski
Dr. R Willinsky
Dr. J Max Findlay
Dr. Christopher Wallace

Case 21

Age: 42

Sex: Male

History: Grand mal seizure x 1. Examination - normal. Placed on Dilantin. No more seizures.

Imaging

CT Head without contrast - June 2003


CT Head with contrast - June 2003. Suggestive of left temporal AVM.




4-vessel angiogram August 2003 showing left temporal AVM with one dominant feeder

Issues

Dominant hemisphere - no bleed. Young patient. Seizure well controlled.

Questions:

Would you:

Leave it alone
Embolization only
Embolization + Surgery (if necessary)
Embolization + stereotaxic radiation/gama knife (if necessary)
Other

January 4, 2004 - Dr. Renn Holness - Neurosurgeon, Halifax

I would treat. Preferably surgery.

January 4, 2004 - Dr. M. Christopher Wallace, Neurosurgeon, Toronto

I would suggest embolization and surgery.

January 4, 2004 - Dr. Karel Terbrugge, Neuroradiologist, Toronto

I suggest embolization first.

January 25, 2004 - Patient referred to Toronto. Embolization done.

Initial post-op angiogram

January 25, 2004 - Dr. M. Chris Wallace, Neurosurgeon, Toronto

Chris:

Clean kill! Great news. AVM completely obliterated. We have an obsessive approach to follow up when we have embo cure because of a few reports in literature regarding recurrence.... always with particle embolization and not glue.

Regards,

Chris

January 27, 2004 - Dr. Karel Terbrugge, Neuroradiologist, Toronto

We believe we obliterated the lesion. Please confirm with follow-up MRI in 2 months and angiogram in 3 months.

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Last Updated: December 23, 2004