Transarterial Embolization of Brain Arteriovenous Malformations

Abstract

Background: Embolization is a safe curative tool in low-gradearteriovenous malformations (AVMs). N-butyl cyanoacrylate(NBCA) and Onyx are comparable to each other depending onthe lesion characteristics.Methods: Starting in 2003, 70 patients (31 males, 39 females;mean age, 29.7y; range, 7 to 72y) with intracranial AVMs wereembolized with NBCA and/or Onyx. Forty-four patients pre-sented with hemorrhage. AVMs were SM grade I in 4 patients,grade II in 21 patients, grade III in 32 patients, grade IV in 9patients, and grade V in 4 patients. AVMS were <3cm in 37patients.Findings: Angiographic cure was achieved in 35 patients (50%,35/70). NBCA was used in 45 AVMs, Onyx was used in 19AVMs, and both agents were used together in 6 AVMs. Per-manent neurological deficits occurred in 1 (1.43%) patient andtransient deficits in 7 (10%/patient, 6.73%/procedure). Hemo-rrhagic complications occurred in 7 patients (10% of patients,6.73% of procedures). Angiographic cure was 75% (3/4) ingrade I AVMs, 61.9% (13/21) in grade II, 43.75% (14/32) ingrade III, 44.44% (4/9) in grade IV, and 25% (1/4) in grade V.AVMs <3cm were cured in 72.97% of patients. There was noprocedure-related mortality. Follow-up for cured cases rangedfrom 6 months to 3 years.Conclusion: Low-grade AVMs can be embolized to cure usingOnyx and NBCA or in combination with high degree of safetyand efficacy. Both agents are similar in cure rate for small-sizedand medium-sized AVMs but with increased number of super-selective navigations and sessions in cases of NBCA with thepossibility of increased complications. Embolization is essentialfor management of high-grade AVMs as a part of the multi-modality approach.Key Words: arteriovenous malformations, Onyx, N-butyl cya-noacrylate (NBCA), superselective, embolization(Neurosurg Q 2013;00:000–000)