부산대학교 도서관

Two cases of ruptured cerebellar arteriovenous malformations (AVMs) and one case of ruptured thalamic AVM with a peripheral aneurysm in their main feeders of AVMs were treated by endovascular techniques. In the first case, the aneurysm was located in the midportion of the superior cerebellar artery (SCA) which fed the nidus; in the second case, the aneurysm was in the anterior inferior cerebellar artery (AICA); and in the third case, the aneurysm was in the medial posterior choroidal artery (MPCA). All aneurysms were thought to be the cause of bleeding from CT and MRI findings. A microcatheter was inserted very carefully just proximal to the aneurysm via the transfemoral route, and after negative results of a provocation test by amytal was confirmed, the aneurysm and nidus were embolized using ethylene-vinyl-alcohol copolymer (EVAL) simultaneously. In each cases disappearance of the aneurysms and reduction of nidus size were recognized after embolization without new neurological deficits. EVAL is a new liquid embolic agent which forms an ethylene-vinyl-alcohol copolymer upon contact with blood and is not adhesive and soft enough to resect after embolization. In cases of AVMs with the peripheral aneurysm in the feeding artery, it is ideal to embolize aneurysms and AVMs simultaneously to prevent a rupture of the aneurysm following the increase in the intraluminal arterial pressure after embolization of the pedicle of AVM. EVAL is an appropriate embolic agent in this type of cases, because it makes repeated injection, possible until the complete disappearance of an aneurysm.