E-066 Pial arteriovenous fistula of the brain associated with choriocarcinoma-seminoma mixed germ cell tumor metastasis: a unique collision metastasis

Brain metastases associated with vascular malformations are described in literature and typically called ‘collision metastases’. In this case, an 18 year-old male with a history of choriocarcinoma-seminoma mixed germ cell tumor status-post orchiectomy and systemic chemotherapy presented to the hospital with left-sided hemiparesis one month after treatment completion. The patient had known metastases to the brain, spleen, and lung. Brain computed tomography (CT) and magnetic resonance imaging revealed a right frontoparietal intracerebral hemorrhage (ICH) attributed to his intracranial metastases (figure 1a). The patient was treated non-operatively and continued his systemic chemotherapy. One month later, the patient presented with headaches and seizures. Brain CT angiogram (CTA) demonstrated a possible abnormal peritumoral vessel. The vessel was considered a normal vessel displaced by mass effect from the hemorrhage. The patient was managed conservatively until he presented again the following month with worsening left-sided hemiparesis. On brain CT, the patient was found to have progression of perilesional edema and ICH of variable chronicity. Brain CTA revealed more conspicuous abnormal vessels at the site of the right frontoparietal metastasis, particularly at the midline near the superior sagittal sinus (SSS). Digital subtraction angiogram revealed a complex pial arteriovenous fistula (AVF) with arterial supply from bilateral middle meningeal arteries and right...
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research