The patient is an eleven year old girl who presented with a painful, discolored swelling behind her left ear. She said the swelling had increased noticeably in size over the previous 6 months.
The swollen area, upon physical examination, proved to be a pulsatile mass, with some reddish discoloration. (Fig. 1A) The results of MRI/MRA imaging was consistent with an extra-cranial AVM, with feeders from the anterior and posterior auricular branches. There was suggestion of feeders from branches of the middle meningeal artery.
Selective angiogram confirmed feeders from the anterior and posterior auricular arteries. (Fig. 2A) Super selective embolization was performed of feeders involved in the auricular cascade with penetration into the draining veins, nidus, and distal dedicated feeding arteries. Concurrently, the ear was packed in ice to stop flow to the normal tissue. One-tenth of a cc of non-opacitied NBCA was used to minimize the mass of embolic material and discoloration. This led to the total obliteration of the AVM.
Follow-up, (Fig. 2B) shows obliteration of the AV shunting. Additional angiography is indicated in 6-12 months to confirm obliteration.