Micro-arteriovenous malformations of the brain: superselective angiography in diagnosis and treatment

We assessed the usefulness of superselective angiography in patients with micro-arteriovenous malformations.

Five patients had superselective angiography for either diagnosis or treatment of brain arteriovenous malformations having a nidus of less than 1 cm. All patients presented with an intracerebral hematoma.

In one patient superselective angiography confirmed the presence of a shunt that was suspected due to visualization of an early vein on the follow-up angiogram; in another patient superselective angiography was helpful in defining the topography of the malformation; in the remaining three patients, superselective angiography was used for embolization of the malformation. We were unsuccessful in achieving a complete angiographic cure in these 3; however, superselective angiography revealed an aneurysm in one that was obliterated by the liquid adhesive embolic agent.

With the recent advances in microcatheters, superselective angiography has a promising role in defining the topography and angioarchitecture of micro-arteriovenous malformations. Micro-arteriovenous malformations may not be angiographically evident at the time of initial hemorrhage due to the hematoma. With future technical advances it may be possible to completely obliterate these malformations by embolization alone.