Diagnosis: right frontal arteriovenous malformations (AVM)
Treatment: implantation of Vivistim paired vagus nerve neurostimulator
The health plan denied the implantation of Vivistim paired vagus nerve neurostimulator.
The health plan's determination is overturned.

The patient is a female with right frontal arteriovenous malformations (AVM) status/post (s/p) multiple embolizations and gamma knife radiation, found to have persistent nidus s/p embolization who subsequently underwent cerebral angio embolization followed by craniectomy with resection.
She was taken back to the operating room (OR) for clot evacuation, right hemicraniectomy and left sided Intracranial pressure monitoring (ICP) bolt placement. She developed left hemiparesis and dysphagia. Cranioplasty was performed and the patient was discharged to rehabilitation.

The proposed treatment, implantation of the Vivistim Paired Vagus Nerve Stimulation System, is likely to be more beneficial than any standard treatment for the insured's disabling condition. The patient has upper extremity monoplegia due to ischemia. The patient will benefit from the treatment. Since then, the patient has completed standard of care outpatient upper extremity rehabilitation, advanced technology upper extremity rehabilitation, non-invasive brain stimulation with transcranial magnetic stimulation (TMS) with some improvement. The patient was evaluated via a telehealth visit. The magnetic resonance imaging (MRI) of the brain showed evidence of ischemia. The patient was diagnosed with monoplegia of the left upper extremity due to ischemia. There was a recommendation for implantation of the Vivistim Paired Vagus Nerve Stimulation System to treat her severe upper limb deficit.

The health plan's determination regarding the proposed treatment is overturned in whole.