Regression of a symptomatic varix after transarterial embolization of a brain arteriovenous malformation: A case report and literature review

Abstract

Rationale:Brain arteriovenous malformation (BAVM)-associated varix is always asymptomatic, and no special treatment is needed. However, there is no consensus regarding how to address a varix that has led to clinical manifestation.Patient concerns:An 11-year-old girl was admitted complaining of left hemiparesis for 4 days. She was previously healthy and denied any history of similar ictus. She was alert, and a physical examination performed upon admission was unremarkable except for the left hemiparesis.Diagnoses:Head magnetic resonance imaging (MRI) showed a linear and round flow void and perilesional edema in the region of the right basal ganglia, indicating a BAVM. Gadolinium-enhanced MRI showed peripheral enhancement of the round lesion. Computed tomography angiography (CTA) showed that the BAVM was fed by the ipsilateral posterior cerebral artery and anterior choroidal artery and drained into the vein of Galen. A large varix was also noted at the top of the BAVM and was consistent with the round flow void observed at the right basal ganglia on MRI. The Spetzler-Martin grading scale was grade IVInterventions:The patient experienced a TAE of the BAVM nidus with liquid embolic agent.Outcomes:A follow-up investigation showed regression of the varix, although there was still some residual BAVM. The patient experienced a favorable recovery.Lessons:In the case of a BAVM-associated symptomatic varix, if surgical resection cannot readily be performed, initial TAE of the BAVM nidus can be attempted.