Growth of Thrombosed Cerebral Venous Varix Following Resection of Cerebral Arteriovenous Malformation: Case Report with Pathologic Consideration

World Neurosurgery
Shinya HaryuTeiji Tominaga

Abstract

Varix of the drainage route can spontaneously develop thrombosis and disappear after the treatment of the associated cerebral arteriovenous malformation (AVM). We report a rare case in which a thrombosed cerebral venous varix of the drainage route exhibited growth despite complete resection of the associated cerebral AVM. A 46-year-old man was diagnosed with an AVM in the left temporal lobe. The AVM was accompanied by a large venous varix in the superficial venous drainage route. Transarterial embolization was performed followed by resection of the nidus. The venous varix in the drainage route was not resected, as it was buried in the temporal lobe of the dominant hemisphere. The venous varix was ligated using a titanium clip and nylon thread. Postoperative angiography confirmed the disappearance of the AVM, and magnetic resonance imaging showed thrombosis of the venous varix. However, follow-up magnetic resonance imaging performed 5 months after surgery showed the enlargement of the thrombosed venous varix and emergence of perilesional cerebral edema. The venous varix was excised by reoperation to prevent further growth. Histopathologic evaluation showed infiltration of macrophages and multinucleated giant cells and proliferat...Continue Reading

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