[Show abstract][Hide abstract] ABSTRACT: Pre-radiosurgical embolization was carried out using cyanoacrylate in seven of 13 patients with cerebral arteriovenous malformations (AVMs) treated by stereotactic radiosurgery (SRS) with a linear accelerator (LINAC). The aim of embolization before SRS was the reduction of AVM volume and/or the elimination of vascular structures bearing an increased risk of haemorrhage. Staged-volume SRS was also performed in two patients because of residual irregular shaped nidus of AVMs even after the embolizations. Complete obliteration of the AVM nidus on angiogram was presented in five patients with embolizations (including one with staged-volume SRS) and in three of six patients with SRS alone, during follow-up periods after radiosurgery. No patients experienced haemorrhagic events after SRS. Although transient neurological symptoms were observed after embolizations in two patients, no permanent neurological deficits were presented in all patients with SRS. Pre-radiosurgical embolization may allow the effective influence on irradiation therapy in relatively large AVMs and promote more frequent obliteration in more small sized AVMs compared to those with SRS alone. However, further study must be needed to determine whether staged-volume SRS provides a high rate of AVM obliteration and its safeness.
[Show abstract][Hide abstract] ABSTRACT: We report a case of dural arteriovenous fistula (DAVF) within the left hypoglossal canal in a 64-year-old man who presented with tinnitus and ocular symptoms. Angiography revealed DAVF with the fistulous pouch medial to the left jugular bulb. The fistula was feeded by meningeal branches of the bilateral ascending pharyngeal arteries and the branches from the left vertebral artery. The fistula shunted into the left jugular bulb, with reflux into the left inferior petrosal (IPS) and cavernous sinuses (Cses), left superior ophthalmic vein (SOV) and cortical veins over the cerebral convexity. We performed transvenous coil embolization to occlude the fistula resulting in complete resolution of symptoms and signs.