• Yu-Hone Hsu, Chung-Wei Lee, Hon-Man Liu, Yao-Hung Wang, and Meng-Fai Kuo.
• Department of Neurosurgery, Cheng-Hsin General Hospital, Taipei, Taiwan.
• World Neurosurg. 2015 Dec 1; 84 (6): 1857-63.

BackgroundBrain arteriovenous malformation (AVM) with a fistulous component presents a treatment challenge. The presence of the fistulous component may be related to either a complication from endovascular treatment, perioperative hemorrhagic events during surgical resection, or incomplete obliteration after radiosurgery.Case DescriptionFrom December 2010 to May 2014, 7 consecutive patients (3 men, 4 women, average age, 28.7 years; age range, 11 months to 67 years) with AVMs with a high-flow fistulous component were treated at our institute with venous coiling before transarterial liquid embolization. One AVM was grade I based on the Spetzler-Martin grading system, 1 was grade II, 3 were grade III, and 2 were grade IV. The nidus size ranged from 1.7 to 6.0 cm. Four patients had pure fistulous-type lesions, and 3 had lesions of the mixed fistulous-plexiform type. All AVMs shared a common feature of a high-flow fistulous component with a large venous pouch emerging from the nidus. After endovascular embolization of the AVMs, 3 patients had complete occlusion, 3 patients had near-complete occlusion, and 1 patient had significant reduction in volume. There was no immediate complication after embolization, but 1 patient experienced delayed hemorrhage 3 days after the procedure.ConclusionsPrioritized transarterial venous coiling is feasible for the embolization of AVMs with a high-flow fistulous component and the procedure had an acceptable complication rate.Copyright © 2015 Elsevier Inc. All rights reserved.

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