Estrogen-alcoholとpolyvinyl acetateによる脳動静脈奇形の塞栓術

Abstract

[Purpose] Advances of intravascular neurosurgery and the introduction of radiosurgery have been changing the treatment strategy for arteriovenous malformation (AVM). We review our original method of embolization and evaluate the initial results.[Methods] This study is based on 138 cases of AVM treated with embolization. Clinical presentation was hemorrhage in 87, convulsion in 36, and others in 15. Embolization using estrogen alcohol (EA) followed by polyvinyl acetate (PVac) was utilized. Fifteen patients were followed by direct surgery and 87 by gamma knife.[Results] Complete obliteration was obtained in 12 patients (8.6%) by embolization alone. Recanalization was not observed in an embolized area at follow-up. Fifteen patients with partial embolization underwent direct surgery and 12 were completely cured. The embolized area was soft and easily resectable. The volume of AVM before and after embolization was evaluated in 87 patients treated with gamma knife. Mean volume was decreased from 11.8 ml before embolization to 5.7 ml after it. Early follow-up of cases that received gamma knife treatment suggests that embolization accelerated the latent period of cure and expanded the indication of gamma knife therapy. The mortality rate was 0.7%, and major and minor morbidity rate was 6.5% and 10.1%, respectively. Overall rebleeding rate of 138 cases was 2.8%/year.[Conclusion] Embolization using EA and PVac cures 8.6% of cases and facilitates surgical removal and radiosurgical treatment. A treatment strategy combing these three modalities is presented.