跟讀練習: Right lateral frontal AVM embolization - 通過影片學習英語口語

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In this video, we will discuss about right lateral frontal AVM,

its angio-architecture and embolization.

28-year female, presented with right frontal partial seizure,

on and off right frontal headache.

CT scan with contrast showed right frontal AVM.

This is lateral view of right internal calvary artery injection which showed high flow AVM at right anterior frontal region.

Avium is fed by multiple feeders from right middle subal artery and anterior subal artery.

The Avium is drained via dilated right anterior frontal cortical vein to superior cital sinus.

From a surgeon perspective, Avium core can be considered as a box shape with a forced surface.

Here we are seeing the Avium from the anterior aspect,

posterior aspect, right lateral and left lateral aspect.

In this particular case, the AVM feeders are entering the AVM core from the inferior aspect

and the draining vein is exiting from the anterior aspect of the AVM.

This is the sketch diagram of AVM.

Here we could see the circumferential feeder artery branching into smaller shunting arterioles

which is shunting the blood to the spiral shaped vessels within the central core.

These spiral vessels are either veins or are dysmorphic vessels.

These spiral vessels are finally draining to superficial cortical vein.

On the left side of the screen we could see the selective injection of the feeder artery.

Here we could see the feeder artery is dividing into tiny vessels

which are shunting arterioles

which is then shunting the blood to the spiral vessels within the AVM core

and we could also see the faint visualization of the draining vein.

In this case the AVM is located at right anterior frontal lobe involving lateral and the orbital surface.

Prefrontal branch of the midislebar artery supply most of the middle frontal gyrus and part of inferior frontal gyrus.

Orbitofrontal branch of the midislebar artery supply orbital portion of middle and inferior frontal gyri.

In this case, the AVM is predominantly supplied by the orbitofrontal branch and prefrontal branch of right middle silver artery.

This AVM is also supplied by the frontopolar branch and anterior internal frontal branch of enterosilber artery.

These feeders from enterosilber artery traversing along the medial surface of hemisphere reaching the frontal pole

and then supplying the avium on the lateral surface of the frontal lobe.

This is right middle meningeal artery injection which showed supply to the basal portion of the avium nidus.

The avium nidus is then draining via superficial frontal cortical vein anteriorly and via orbital vein to the sylvan vein posteriorly.

This 3D fusion image showed two separate components of the avium nidus,

anterior superior portion of the avium nidus fed by the intracranial feeders

and basal portion of the avium nidus are fed by middle meningeal artery feeders.

The avium was planned for stage embolization with aim to achieve cure by endovascular root.

In the first session three feeders were selectively catheterized and avium nidus was embolized.

This is selective micro catheter injection of prefrontal branch of right MCA which was embolized using squid.

This is right middle feeder artery injection and this feeder artery was embolized using 20% glue.

Finally, right frontopolar feeder artery was selectively catheterized using magic microcatheter and was embolized using 20% glue.

This is the final embolic cast.

Final angiogram revealed approximately 50% reduction of the AVM NIDA score.

Thank you.

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跟讀練習: Right lateral frontal AVM embolization - 通過影片學習英語口語

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