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Successful treatment of an arteriovenous malformation by chemical embolization with estrogen followed by conventional radiotherapy.

A case of the successful treatment of a thalamic arteriovenous malformation (AVM) by chemical embolization with conjugated estrogen followed by conventional radiotherapy is described. A 22-year-old woman suddenly developed headache, nausea, and consciousness disturbance. Computed tomographic scans revealed left thalamic and ventricular bleeding. Angiograms disclosed a left thalamic AVM with a maximum diameter of 2 cm. The AVM was fed mainly by the left medial posterior choroidal artery and drained into the basal vein. Chemical embolization with 300 mg of conjugated estrogen via a leak balloon catheter was carried out. Although the size of the nidus of the AVM was unchanged immediately after embolization, it became smaller 9 days later. In spite of the further reduction in size, the AVM still existed 2 years later. Conventional radiotherapy with a total dose of 30 Gy was performed. Follow-up angiograms 40 months after radiotherapy demonstrated disappearance of the AVM. This case report suggests progressive and stable embolizing capabilities of chemical embolization with conjugated estrogen and its suitableness for following radiotherapy, including stereotactic radiosurgery.