Successful transfer of “free” microvascular superficial temporal artery flap with no obvious venous drainage and use of leeches for reducing venous congestion: Case report

Introduction. Arteriovenous malformations (AVM) of the head represent the rare lesions that have a congenital, traumatic or post-infectious nature. In the last decade, endovascular methods have become the most prevalent in the treatment of AVM. Staged embolization is performed to achieve maximum eﬀect and minimize the complications.Case report. A 30-year-old female patient is presented with complaints of enlarged vessels in the frontal and parietal regions. CT-angiography scan and cerebral angiography showed extracranial AVM of the fronto-parietal regions with aﬀerent vascular supply from the right and left superﬁcial temporal and ophtalmic arteries with signiﬁcant expansion of the aﬀerent arteries and the presence of varix dilatation of the draining veins. Two-stage endovascular embolization of AVM was performed. The ﬁrst stage was embolization of the aﬀerent vessels from the left superﬁcial temporal artery system with exclusion of 60–65% AVM volume. Three months later, the second stage was performed with embolization of the afferent vessels from the right superﬁcial temporal artery system and the exclusion of 75–80% of the residual volume of AVM. The non-adhesive composition SQUIDR12 (Emboﬂu, Switzerland) and glue composition PHILR25% (Microvention, USA) were used. A good aesthetic eﬀect was achieved. Postoperative complications were not observed. There was no recurrence during the observation within a year.Summary. The staging and the use of various liquid embolization agents in the treatment of AVM of the head allow to achieve a good aesthetic outcome and prevent complications associated with facial soft tissue necrosis.

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Case Report: Reversible Cerebral Vasoconstriction Syndrome in a cancer patient using ZoladexTM

10.5327/1516-3180.142 ◽

2021 ◽

Author(s):

Paolla Giovanna Rossito de Magalhães ◽

Marina Buldrini Filogonio Seraidarian ◽

Bernardo Tardin Caetano ◽

Barbara Oliveira Paixão ◽

Tassila Oliveira Nery de Freitas ◽

...

Keyword(s):

Case Report ◽

Cerebral Angiography ◽

Postpartum Period ◽

Cerebral Arteries ◽

Superficial Temporal Artery ◽

Chronic Administration ◽

Temporal Artery ◽

Reversible Cerebral Vasoconstriction Syndrome ◽

Gnrh Analogue ◽

Cerebral Vasoconstriction

Context: The Reversible Cerebral Vasoconstriction Syndrome (SVCR) is characterized by rapid and reversible vasoconstriction and segmental dilation of cerebral arteries, usually preceded by thunderclap headache. The involvement of second and third-order branches of the cerebral arteries is the most commom finding in a cerebral angiography. This report is about a SVCR case with atypical involvement, significantly compromising extracranial vessels and raising the hypothesis of association between the use of hormonal blocker gosserelin acetate (ZoladexTM) with SVCR. Case report: Female, 39 years old, with breast cancer and bone metastasis using ZoladexTM that presented with a sudden headache and vomiting, progressing to global afasia and paresis in the right upper limb. Magnetic resonance identified hyperacute intraparenchymal hematoma in left frontoparietal convexity and subarachnoid haemorrhage. Cerebral angiography showed irregularities in the distal branches (M3 and M4) of the middle cerebral arteries, as well as in the superficial temporal artery, characterized by focal strictures. Conclusion: Studies show that hormonal fluctuations in the postpartum period can trigger SVCR due to the drop in estrogen and progesterone (gonadotropins). During postpartum, the stimulus of breastfeeding increases prolactin levels leading to GnRH suppression, which decreases the level of gonadotropins. ZoladexTM is a GnRH analogue and its chronic administration results in suppression of these hormones - similar to the postpartum period. Therefore, there may be an association of hormonal blockers with SVCR.

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