A young woman with a first-time seizure and a huge intracranial vascular structure

摘要

A 27-year-old woman presented with a first-time seizure. MRI of the head showed a large, 7 cm, round vascular structure inside the right lateral ventricle with mass-effect (figure A). Simultaneous right carotid and vertebral angiography (figure B and video 1) showed a direct high-flow arteriovenous shunt (figure B, arrow) between the right posterior cerebral artery and a grossly dilated subependymal ventricular vein. An aneurysm on the supraclinoid internal carotid artery was also seen (figure B, arrowhead). A microballoon catheter was flow directed to the afferent artery and a second microcatheter positioned just distal to the balloon (figure C, arrow points to tip of catheter). With the balloon inflated, the flow stopped and ethyl-vinyl-alcohol-copolymer glue (EVOH, Onyx, ev3, Raynham, MA, USA) could be slowly injected distal to the balloon just proximal to the shunt (figure D, arrow) was closed and the carotid aneurysm was occluded with coils (figure D, arrowhead). Control angiography showed complete closure of both the shunt and the aneurysm (figure E, arrows, and video 2). MRI of the head the next day (figure F) showed the decreased size of the dilated vein with signal intensities consistent with thrombus.