A CASE OF VESSEL PERFORATION DURING INTERVENTIONAL NEURORADIOLOGICAL PROCEDURE - OPERATIVE FINDINGS OF THE PERFORATED VESSEL

A case of vessel perforation by a guide wire during an interventional neuroradiological procedure is reported. The patient was a 59-year-old woman with a left frontal basal arteriovenous malformation (AVM) fed by the left anterior cerebral artery. Transarterial embolization of th e AVM was attempted. During the procedure, vessel perforation by the g uide wire occurred at the left A1-A2 junction and resulted in subarach noid hemorrhage, which stopped spontaneously. The patient developed pr ogressive obstructive hydrocephalus, and surgical treatment was perfor med. The AVM was totally removed after ventricular drainage, and the a rterial perforation site was explored. When clot around the left A1-A2 junction was removed, hemorrhage recurred. This hemorrhage was simila r to what has been observed when a small perforating artery was avulse d. The hemorrhage site was coagulated under temporary occlusion of bot h A1 segments. Surgical intervention was probably not necessary for th is type of bleeding if it had stopped spontaneously, because the reble eding from the small pinhole would be unlikely, and the operation was more hazardous than the usual aneurysmal surgery.