[Nidus embolization of cerebral arteriovenous malformation fed mainly by a pericallosal artery prior to surgical excision. Case report].

Nidus embolization of large arteriovenous malformation (AVM) by silastic spheres is not rarely performed prior to surgical excision of AVM. This technique is highly indicated for the large AVM supplied by the middle and the posterior cerebral arteries since silastic spheres injected into either the internal carotid or the vertebral arteries usually enter the middle or the posterior cerebral arteries due to less sharp angle from the main arteries. The authors report a case whose AVM, fed mainly by the anterior cerebral artery, was successfully embolized with silastic spheres using balloon catheter technique. On December 1, 1983, a 27-year-old man was admitted to our department with chief complaint of headache and clonic convulsion of the left upper and lower limbs. Convulsion began in 1973 and severe headache suddenly appeared two months prior to admission. He was neurologically asymptomatic on admission. Right internal carotid angiogram taken on admission showed a presence of large arteriovenous malformation in the medial portion of the right fronto-parietal lobe and corpus callosum fed mainly by the right pericallosal artery. Nidus embolization with silastic spheres was planned to make surgical removal easier. To prevent stray of silastic spheres into the right middle cerebral artery, balloon, introduced into the M1, was inflated for a few minutes, during which time, injection of 40 silastic spheres of 1.5 and 2.0 mm in diameter was performed via the right internal carotid artery. The nidus was significantly reduced and total removal of the nidus was successfully done 28 days following the embolization.(ABSTRACT TRUNCATED AT 250 WORDS)