Fatal hemorrhagic complication after coil embolization of a petrosal arteriovenous shunt.
Interv Neuroradiol
; 28(6): 629-633, 2022 Dec.
Article
in En
| MEDLINE
| ID: mdl-34775852
ABSTRACT
BACKGROUND:
Cerebello-pontine AVMs (CPAVMs) and petrous apex dural arteriovenous fistulae (DAVFs) are rare and sometimes difficult to distinguish. We report a fatal hemorrhagic complication after coil embolization of the petrosal vein draining a trigeminal AVM misdiagnosed as a DAVF. CASE PRESENTATION A 73-year-old woman with a petrous apex arteriovenous shunt with dual dural and pial arterial supply presented with posterior fossa hemorrhage. The draining petrosal vein was catheterized and coiled via the superior petrosal sinus. Two episodes of contrast extravasation occurred during coiling, but the lesion was completely occluded at the end of the procedure. The patient developed a fatal posterior fossa hemorrhage in the recovery room. Microscopic pathology revealed numerous dilated vessels within the trigeminal nerve.CONCLUSION:
CPAVMs and DAVFs with pial drainage should be distinguished pre-operatively. Occlusion of a pial vein (as opposed to a sinus) in the treatment of an arteriovenous shunt carries hemorrhagic risk if a liquid embolic agent is not used to completely occlude all pathological vessels.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cerebral Veins
/
Arteriovenous Fistula
/
Central Nervous System Vascular Malformations
/
Embolization, Therapeutic
Limits:
Aged
/
Female
/
Humans
Language:
En
Journal:
Interv Neuroradiol
Journal subject:
NEUROLOGIA
/
RADIOLOGIA
Year:
2022
Document type:
Article
Affiliation country:
Canadá