Embolization of a dural arteriovenous malformation using Gianturco coils.

A 16-year-old girl was seen by a local ophthalmolog ist because of diplopia and fullness of the right eye. Exam ination revealed visual acuity of 20/20 in both eyes with a 2-3 mm proptosis of the right eye. The right eye was also displaced downward with restri c tion of upward gaze and redness of the right canthus. There was a machineli ke bruit over the right eye and a thrill over the right supraorbital reg ion. The patient was admitted to the hospital for further evaluation and treatment. Right-sided selective internal and external angiog raphy revealed a dural arteriovenous malformation in the supraorbital and subfrontal regions. The major feed ing arteries were the middle deep temporal and middle meningeal arteries from the internal maxillary artery and , a lesser contribution, th e ethmoidal meningeal artery from a branch of the ophthalmic artery (fig . 1). Because the external carotid artery was the major feeding artery of the large dural arteriovenous malformation, superselective catheterizat ion was done and a 3 mm mini Gianturco coil was introduced through a size 5 French catheter. Postembolization extern al carot id arteriography revealed a complete occlusion of th e middle meningeal artery as well as the distal part of the intern al maxillary artery (fig. 2A). A postembolization selecti ve internal carotid arteriogram revealed filling of the aneurysmal dilated venous sac from the ethmoidal branch of the ophthalmic artery. Ph ysical examinat ion at that time revealed a decreased orbital bruit and improvement of the diplopia. Five days later, a frontotemporal craniotomy was performed and the residual dural arteriovenous malformation was exposed . An 18 gauge need le was direct ly inserted into the aneurysmal venous sac and 8 mm Gianturco coils were introduced . After this, the medium (5 mm) and mini (3 mm) coils were injected. A total of 18 coils were introduced until there was no blood return through the needle. The craniotomy was closed and the postoperative course was uneventful. Postoperative arteriography revealed the dural arteriovenous malformation (AVM) to be completely occluded by the coils in the