[Efficacy of nidus embolization of large arterio-venous malformation prior to surgical excision]

Although it is undoubted that surgical excision is the ideal treatment for arterio-venous malformation, its large nidus and deep localization make it difficult in some instances. To make surgical procedure easier, efficacy of nidus embolization or of obstruction of feeding arteries by detachable balloon technique is reported. A case presented here is such a case with large arterio-venous malformation which was successfully removed surgically following artificial nidus embolization with silastic spheres. On May 12th, 1983, a 27-year-old housewife was admitted to our department with chief complaints of episodes of alexia, apraxia, and aphasia lasting for a few minutes during 4 years prior to admission. Neurological examination on admission showed no abnormalities. Left internal carotid angiogram taken on admission showed a large arterio-venous malformation in the left parieto-temporo-occipital region fed by three branches of the left middle cerebral artery and two branches of the left posterior cerebral artery (Fig. 2a, 3a). To enable successful excision without neurological deficits, nidus embolization with silastic spheres was performed on June 2, 1983. Forty silastic spheres of 1.5 mm in diameter were injected via a catheter introduced in the left internal carotid artery and a second injection of 48 silastic spheres of 2.0 mm in diameter was performed after confirmation of no stray of silastic spheres in the arteries unrelated to the nidus. Embolization procedure was interrupted after the second injection, because of stray of silastic sphere into the posterior internal frontal artery of the left anterior cerebral artery.(ABSTRACT TRUNCATED AT 250 WORDS)