Figure 3.

A 41-year-old with Spetzler-Martin grade 6 arteriovenous malformation involving the mesial temporal and occipital regions. He presented with headache, right-sided numbness, paresthesias, and seizures (case courtesy of David Kumpe, M.D.). (A) Digital subtraction angiography of a branch artery demonstrates a large posterior cortical arteriovenous malformation. Multiple feeding arteries are supplying the nidus (or multiple nidi) of the arteriovenous malformation. Embolization at the current level of the catheter would occlude too many arteries, placing the underlying brain at risk from nontarget embolization. (B) Digital subtraction angiography following advancement of the catheter to a position closer to the nidus of the arteriovenous malformation. Embolization with a liquid embolic agent from here should minimize the risk of nontarget embolization. (C) Scout image from a computed tomography scan following multiple embolization procedures demonstrates the relatively large amount of radiopaque n-butyl cyanoacrylate used during this multistage embolization procedure.