Spontaneous Occlusion of a Complex Brain Arteriovenous Malformation Following Partial Embolization.

Abstract

Curative embolization for cerebral arteriovenous malformation (AVM) cannot always be achieved. Rather, embolization plays a role in AVM treatment as an adjuvant therapy before radiosurgery and microsurgery. Curative embolization for large, complex AVMs is not commonly seen. A man in his 30s with an unruptured left cerebral AVM underwent radiosurgery in 2014 and was lost to follow-up. He presented with intracerebral hemorrhage in 2019, and diagnostic cerebral angiography demonstrated a large, complex AVM. The patient was scheduled for 2-stage embolization in preparation for microsurgical resection. Initial embolization targeted and occluded 20% of the AVM nidus involving primarily the anteroinferior portion. A cerebral angiogram obtained 5 weeks following initial embolization revealed spontaneous occlusion of the remaining AVM. There are few reported cases of spontaneous occlusion of a large, complex AVM following embolization with previous radiation therapy. The spontaneous occlusion in this case suggests that at least some AVMs that receive embolization after radiation, rather than before, may have a potential for spontaneous, curative thrombosis.