Abstract
BackgroundEmbolization for cerebral arteriovenous malformations (AVMs) has evolved in the last decade with evolution in both equipment and material. Embolization targets have expanded to include angiographic cure.MethodsTo discuss the technical and management outcomes of our first cerebral AVM case series treated with embolization. The clinical, angiographic, treatment, and outcome variables of consecutive cerebral arteriovenous malformation cases, treated with curative embolization, between January 2011 and June 2017 in one regional center, were retrospectively analyzed.ResultsIn 21 patients, 21 AVMs were identified, and 13 patients (61.9%) were males. The mean of the age was 34.24 ± 12.99. Fifteen patients (71.4%) had a history of intracranial hemorrhage, and 10 (47.6%) patients had seizures. Sixteen patients (76.2%) were at grade 1 of modified Rankin Scale (mRS) at admission. The median for modal Spetzler-Martin grade was 2. The average number of arterial feeders was 3. Direct arteriovenous fistulas were found in 4 cases (19.0%). Venous aneurysms were found in 4 cases (19.0%). Seventeen AVMs (80.9%) were considered high bleeding risk lesions. Forty-three embolization sessions were done. Early hemorrhage occurred in 3 sessions (7.0%). Vessel perforation occurred 1 session (2.3%). Poor outcome occurred in 1 patient that was discharged at grade 3 mRS. Angiographic cure was achieved in 9 patients (42.9%). The average size reduction was 65%.ConclusionsOnyx embolization could serve as a curative option for AVM treatment with accepted morbidity and mortality.
Highlights
Embolization for cerebral arteriovenous malformations (AVMs) has evolved in the last decade with evolution in both equipment and material
Hemorrhage occurred in 3 sessions (7.0%) for 2 patients (9.5%); all were treated conservatively with good functional recovery
Angiographic cure was achieved in 9 patients (42.9%)
Summary
Embolization for cerebral arteriovenous malformations (AVMs) has evolved in the last decade with evolution in both equipment and material. The target of embolization has evolved, starting as preoperative embolization to facilitate AVM resection (Crowley et al 2014) It is not approved yet by the US Food and Drug Administration (FDA), pre-radiosurgical embolization is performed to eliminate high-risk features or to reduce nidal size (Pierot et al 2013a). With evolution in both materials [e.g., ethylene-vinyl alcohol co-polymer (EVOH)] and techniques, the indications for endovascular embolization of cerebral arteriovenous malformations (AVMs) have expanded to include curative embolization (Mounayer et al 2007; Panagiotopoulos et al 2009). Onyx (EVOH) in comparison to NBCA is less thrombogenic with minimal
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