PRE-OPERATIVE REPORT

NEUROVASCULAR DIVISION
Friday, December 09th 2022

Name : Mr. Mohammad Saefulloh

Sex : Male
Age : 48 yo
MR : 0001997618
Admission : December 08th 2022
Ward : Kemuning 4th Ward

WD/ Post DSA & Embolization due to Arteriovenous Malformation

Supplemented Spetzler-Martin Grade 6 at Right Frontal

TH/ DSA + Embolization

Consultant : Dr. dr. Achmad Adam, Sp.BS.(K), M.Sc

 Mr. M. Saefulloh / ♂ / 48 yo / 0001997618 / Vascular / AD
CC: History of Seizure

August 2021 November 2021

History of seizure, preceded Underwent DSA at Santosa Central December 2022

by intermittent headache 
Non-Contrast Head CT Scan +
Contrast Head MRI MRA +
EEG (September 2021) 
Suspect AVM
Hospital Bandung by Neurologist 
AVM  referred to Neurosurgery Plan for DSA + Re -
Outpatient Clinic RSHS Embolization
May 2022
Underwent DSA + Embolization

History of hypertension (-), DM (-). History of previous stroke (-), history of anticoagulant consumption (-), history of smoking (+) > 20 years,
and history of alcohol consumption (-).
General state :
BP : 120/80 mmHg P : 92 x/mnt RR : 18 x/mnt T : 36.4 °C

Local State :
At Thorax : Symmetrically shape and movement, VBS Right = Left, Rh -/-, Wh -/-

Neurological States :
GCS 15, nuchal rigidity (-)
Pupil : Round equal ODS 3 mm/ 3 mm, LR +/+
Visus : ODS > 6/60
Funduscopy : Not Performed
Eyeball movement : Good to all direction
Other cranial nerve : Within normal limit
Motoric : No parese
Sensoric : Within normal limit
Physiologic Reflex : +/+
Pathologic Reflex : Babinski -/-
Laboratory Findings at Hasan Sadikin Hospital, Bandung
November 30th 2022

Labs Result Labs Result

Hb 15.3 Na/K 141/4.3
Ht 44.6 Ur/Cr 20.5/0.88
L 7.110 OT/PT 17/14
Tr 235.000 RBG 93
PT/APTT/ INR 14.4/31.5/1.04

Labs Result
Rapid Antigen
Sars Cov2 Negative
(Dec 8th 2022)
Thorax X-Ray at Hasan Sadikin Hospital, Bandung
November 30th 2022

Within Normal Limit

EEG at Borromeus Hospital, Bandung
September 25th, 2021

Within Normal Limit

Non-Contrast Head CT Scan at Borromeus Hospital
September 24th, 2021
• Sulci and gyri are not compressed
• Sylvian fissure are not
compressed
• Ventricles and cisterns are not
compressed
• Hyperdense lesion at right frontal
• Perifocal edema (+)
• Midline shift (-)
Contrast Head MRI & MRA at Borromeus Hospital
September 24th, 2021
Contrast Head MRI & MRA at Borromeus Hospital
September 24th, 2021
Contrast Head MRI & MRA at Borromeus Hospital
September 24th, 2021
Contrast Head MRI & MRA at Borromeus Hospital
September 24th, 2021
 Contrast Head MRI & MRA at Borromeus Hospital
September 24th, 2021

- AVM with nidus size 4,5 x 3,4 cm at right frontal with feeding artery right superficialis
frontal and ACA with drainage to right cortical superficial frontal vein
- Spetzler Martin Grade : 2
• Size : 3-6 cm : 2
• Location : Non-eloquent : 0
• Pattern of Venous Drainage : Superficial component : 0
DSA at Santosa Central Hospital Bandung
November 06th, 2021
RICA : segmen A1 aplastik, segmen
M1-M2 dilatasi. Terlihat AVM
sulcogyral yang mendapat suplai dari
segmen M2 MCA, dengan ukuran
4.1x4.2 cm. Vena drainase terlihat
tunggal ke sinus sagitalis superior.

LICA : A com artery terlihat memberi

suplai ke segmen A2 kanan dan kiri.
Terlihat AVM ukuran 3.4x3.7 cm
dengan vena drainase ke SSS. AVM
mendapat feeder dari segmen A2 ACA
kanan dan kiri.

Kesimpulan: AVM frontal kanan

dengan feeder dari segmen M2 MCA
kanan, MMA kanan, A2 ACA kanan dan
kiri. Vena drainase tunggal ke SSS.
Mr. M. Saefulloh / ♂ / 48 yo / 0001997618 / Vascular / AD
May 18th, 2022
Left Vertebral Artery AP Left Vertebral Artery Lat
Mr. M. Saefulloh / ♂ / 48 yo / 0001997618 / Vascular / AD
May 18th, 2022
Left Ext Carotid Artery AP Left Ext Carotid Artery Lat
Mr. M. Saefulloh / ♂ / 48 yo / 0001997618 / Vascular / AD
May 18th, 2022
Left Internal Carotid Artery AP Left Internal Carotid Artery Lat
Mr. M. Saefulloh / ♂ / 48 yo / 0001997618 / Vascular / AD
May 18th, 2022
Right Vertebral Artery AP Right Vertebral Artery Lat
Mr. M. Saefulloh / ♂ / 48 yo / 0001997618 / Vascular / AD
May 18th, 2022
Right Ext Carotid Artery AP Right Ext Carotid Artery Lat
Mr. M. Saefulloh / ♂ / 48 yo / 0001997618 / Vascular / AD
May 18th, 2022
Right Internal Carotid Artery AP Right Internal Carotid Artery Lat
Mr. M. Saefulloh / ♂ / 48 yo / 0001997618 / Vascular / AD
May 18th, 2022

Digunakan embolan:
Squid 12
 RIGHT EXTERNAL CAROTID
May 18th, 2022
Pre Embolization Post Embolization
 RIGHT EXTERNAL CAROTID
May 18th, 2022
Pre Embolization Post Embolization
 DSA PREPARATION
CATHETERS
ANESTHESIA

VASCULAR SHEATH

GUIDE WIRES
ELASTOPLAST STRIPS

MAGIC Flow dependent catheter

CONTRAST ANTICOAGULANT
DSA PROCEDURE
DSA PROCEDURE
DSA PROCEDURE

L.C.C

Left subclavian

Brachiocephalic
DSA PROCEDURE
 DSA PROCEDURE

ICA AP and lateral view

Internal Carotid AP and Lateral View

 DSA PROCEDURE

Vertebrobasilar AP and Lateral View

LIQUID EMBOLIZATION PLAN
LIQUID EMBOLIZATION PLAN
THANK YOU