Embolic pulmonary complication of a cerebral arteriovenous malformation treatment

IMAGEM EM MEDICINA

Embolic pulmonary complication of a cerebral arteriovenous malformation treatment

Lucas Alverne Freitas de Albuquerque^I; João Paulo Cavalcante de Almeida^II

^I Intern, Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil

^II Intern, Neurosurgery, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil

^{Correspondence to}

A 34-year-old man was admitted in the emergency room with headache, vomiting, gait ataxia, dizziness and vertigo. He was submitted to a cranial CT that showed an important hydrocephalus secondary to a forth ventricle compression by a posterior fossa hematoma. He received advanced life support in an intensive care unit (ICU) and was submitted to an external ventricular drainage (EVD), posteriorly converted to ventriculoperitoneal shunt (VPS) (visualized in the right hemithorax). After stabilization a magnetic resonance image (MRI) and an arteriography revealed a large cerebellum arteriovenous malformation (AVM).

It was decided to treat the AVM with surgery preceded by endovascular embolization with N-butyl-cyanoacrylate (Histoacryl). One day after the third section of embolization, the patient evolved to moderate respiratory distress. The x-ray revealed migration of the Histoacryl to the lung. The patient developed respiratory insufficiency and died.

Although nidus embolization with Histoacryl is an effective and safe technique that may permit complete cure of brain AVMs, with or without surgical resection and/or radiosurgery, serious complications are described^1-3. There is no specific data related to Histoacryl migration frequency in the endovascular therapy, but it has already been described in the treatment of bleeding gastric ulcer and skull base tumors, as anecdotal cases^4-7.

Study conducted at Hospital Geral de Fortaleza, Fortaleza, CE, Brazil

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• 5. Lee GH, Kim JH, Lee KJ, Yoo BM, Hahm KB, Cho SW et al. Life-threatening intraabdominal arterial embolization after histoacryl injection for bleeding gastric ulcer. Endoscopy 2000;32(5):422-4.
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• 7. Casasco A, Houdart E, Biondi A, Jhaveri HS, Herbreteau D, Aymard A et al. Major complications of percutaneous embolization of skull-base tumors. AJNR Am J Neuroradiol 1999;20(1):179-81.

Publication Dates

• Publication in this collection
  25 Aug 2011
• Date of issue
  Aug 2011