Curative multistage embolization of symptomatic multiple (supra- and subtentorial) arteriovenous malformations with a distal flow-related aneurysm.

We present a unique case report of curative three-stage embolization of multiple bilateral cerebral arteriovenous malformations of supra- and subtentorial localization (left temporal lobe, vermis and right cerebellar hemisphere) combined with a flow-related aneurysm of the P4-P5 segments of the right posterior inferior cerebellar artery. A patient in their 40s. Clinical manifestation in 2011 (over 10 years ago) with intracerebral haemorrhage. During three stages of embolization with non-adhesive embolic materials (Squid 12,18, BALT), all arteriovenous malformation (AVMs) were obliterated and the flow-related aneurysm was reduced. Both transarterial and transvenous approaches were used. Adenosine-induced cardioplegia and pressure cooking (in the case of transvenous approach) were used to reduce flow and control reflux. This example shows that the combination of modern technological methods and an optimal strategy of sequential endovascular embolization with non-adhesive compositions can be an effective and safe method for the treatment of multiple AVMs, leading to favorable clinical outcomes.