Embolization Of Brain Arteriovenous Malformations Research Articles

Penetration Difference of n-Butyl 2-Cyanoacrylate into the Nidus in the Embolisation of Brain Arteriovenous Malformation

Prediction of nidal penetration of the glue is difficult in the embolisation of brain arteriovenous malformations (AVM). We evaluated penetration differences of glue-lipiodol mixtures with and without tungsten powder for embolisation of brain AVM. Fifty eight injections during embolisation of brain AVM in 15 patients were evaluated. Glue contained lipiodol only (N=25), or lipiodol and tungsten powder (N=33). Glue concentration ranged from 20 to 80%. Injection was done at the pedicle (N=41) or nidus (N=17). Degree of penetration was rated as good, fair, or poor according to penetrated glue amount in the nidus. Penetration difference was compared in each injection at the pedicle or nidus. When the glue mixtures were injected at the pedicle, the glue-lipiodol mixture (GLM) penetrated into the nidus in eight of 16 injections (50%) and the glue-lipiodol-tungsten mixtures (GLTM) in 23 of 25 (92%). When glue was injected at the nidus, GLM was confined to the nidus in nine of nine injections (100%) and GLTM in seven of eight (88%). Penetration into the vein was noted in two of 25 injections (8%) in GLM and six of 33 (18%) in GLTM. Penetration difference into the nidus between GLM and GLTM was statistically significant (p < 0.05) when the glue mixtures were injected at the pedicle. GLM and GLTM can be used effectively at the nidus. In contrast to GLM, GLTM can be used effectively at the pedicle. However, the risk of venous penetration seemed to be higher with GLTM than in GLM.

Embolization of the Nidus of Brain Arteriovenous Malformations with n-butyl Cyanoacrylate

OBJECTIVE : To demonstrate that nidus embolization of brain arteriovenous malformations (AVMs) with Histoacryl (B. Braun, Melsungen, Germany) is effective and yields low morbidity and mortality rates. METHODS : We present a retrospective analysis of 54 brain AVMs treated at the University of Illinois at Chicago from April 1994 to December 1995. Treatment modalities included embolization in all cases and then surgical resection or radiosurgery. INSTRUMENTATION : The nidus was reached with the combined use of a Magic microcatheter (Balt, Montmorency, France) and a Terumo 0.010-inch guidewire. TECHNIQUE : Embolization was performed only when the tip of the microcatheter was wedged into the nidus of the AVMs with no reflux of contrast proximally. The embolization was performed using simultaneous biplane roadmapping with the patient under general anesthesia without Amytal testing. RESULTS : Twenty-six of 54 patients are still waiting for more radical treatment. Two deaths and two minor and one severe permanent neurological deficit occurred. Three patients were cured with embolization alone ; 11 patients were cured after surgical resection. Three patients underwent radiosurgery, with one cure after 1 year. CONCLUSION : Nidus embolization with Histoacryl is an effective technique that permits complete cure of a large number of brain AVMs, with or without surgical resection and/or radiosurgery.

Ethanol Endovascular Management of Brain Arteriovenous Malformations: Initial Results

The goal was to determine the safety and efficacy of absolute ethyl alcohol treatment in the management of intra-axial brain arteriovenous malformations (AVMs). Seventeen patients (eight female and nine male patients; mean age, 41 yr) underwent ethanol endovascular therapy for treatment of their brain AVMs. Superselective amytal testing preceded all procedures. Neuroleptic intravenous anesthesia was used for 16 patients, and general anesthesia was used for 1 patient. Follow-up monitoring consisted of clinical evaluations, magnetic resonance imaging, and arteriography. In follow-up evaluations (mean follow-up period, 13 mo) after embolization of brain AVMs, neither vascular recanalization nor the neovascular recruitment phenomenon was observed in any patient. Progressive AVM thrombosis at arteriographic follow-up evaluation was a constant feature. Seven patients were cured of their AVMs with ethanol endovascular therapy alone. Three patients were cured of their lesions with ethanol embolization plus surgical resection. One patient was cured of his lesion with ethanol embolization and radiation therapy of the residual nidus. Three patients underwent only partial therapy, with significant improvement in symptoms. Three patients are currently undergoing ethanol endovascular therapy. Complications occurred with 8 of 17 patients, most of which were transient. Two patients died because of late subarachnoid hemorrhages, one patient 4 months and one patient 14 months after partial therapy. Progressive and permanent AVM occlusion is a common finding in arteriographic follow-up evaluations. In no patients did arterial recanalization or the neovascular recruitment phenomenon occur. Our initial results indicate that ethanol has a permanence that is seldom encountered with other embolic agents. With aggressive decadron therapy, the complications related to swelling in the brain are largely reversible.

Contribution of interventional neuroradiology in the therapeutic management of brain arteriovenous malformations

Interventional neuroradiologists have accumulated more than 20 years of experience in intravascular embolization of brain arteriovenous malformations (AVMs). Since 1986, there has been a steady improvement in the technical quality of microcatheters and neuroimaging techniques that permit safer superselective catheterization of intracranial vessels ~ (Fig 1). The two main types of microcatheters used for intracranial navigation are the over-the-wire microcatheter and the flow-guided microcatheter. The first type is positioned in the intracranial circulation by first placing a small, torqueable radiopaque microguidewire into the selected artery and then tracking the catheter over the wire. Its relatively large lumen allows the delivery of a wide selection of particulate and liquid embolic materials. The flow-guided microcatheter is carried by the blood flow without the need of a guidewire. It is very supple and may reach distal cortical and perforating cerebral arteries with less morbidity. Its lumen is smaller, limiting the use of embolic material to liquids or very small particles. At our institution, with the active participation of vascular neurosurgeons, interventional neuroradiologists, and stereotactic neurosurgeons, we conduct neurovascular rounds regarding patients with brain AVMs. The neuroimaging anatomic (head computed tomography, magnetic resonance imaging and angiography, and cerebral angiography), functional (magnetic resonance imaging, positron-emission tomography, superselective Amytal testing), and dynamic information (intravascular pressure monitoring, transcranial Doppler, xenon cerebral blood flow) is discussed, and a corresponding therapeutic strategy is developed. 2

Embolization of the Nidus of Brain Arteriovenous Malformations withn-Butyl Cyanoacrylate

To demonstrate that nidus embolization of brain arteriovenous malformations (AVMs) with Histoacryl (B. Braun, Melsungen, Germany) is effective and yields low morbidity and mortality rates. We present a retrospective analysis of 54 brain AVMs treated at the University of Illinois at Chicago from April 1994 to December 1995. Treatment modalities included embolization in all cases and then surgical resection or radiosurgery. The nidus was reached with the combined use of a Magic microcatheter (Balt, Montmorency, France) and a Terumo 0.010-inch guidewire. Embolization was performed only when the tip of the microcatheter was wedged into the nidus of the AVMs with no reflux of contrast proximally. The embolization was performed using simultaneous biplane roadmapping with the patient under general anesthesia without Amytal testing. Twenty-six of 54 patients are still waiting for more radical treatment. Two deaths and two minor and one severe permanent neurological deficit occurred. Three patients were cured with embolization alone; 11 patients were cured after surgical resection. Three patients underwent radiosurgery, with one cure after 1 year. Nidus embolization with Histoacryl is an effective technique that permits complete cure of a large number of brain AVMs, with or without surgical resection and/or radiosurgery.

Cure, Morbidity, and Mortality Associated with Embolization of Brain Arteriovenous Malformations

Published reports of cure, morbidity, and mortality associated with the embolization of 1246 brain arteriovenous malformations during the last 35 years were reviewed. Embolization resulted in cure in 5% of arteriovenous malformations. The cure rates of embolization were 4% in reports of 708 patients published before 1990 and 5% in reports of 538 patients published since 1990 (P = not significant). Temporary morbidity from embolization was 10%, and permanent morbidity was 8%. Permanent morbidity was 9% before 1990 and 8% since 1990 (P = not significant). Death after embolization of brain arteriovenous malformations occurred in 1% of patients. Mortality associated with the embolization was 2% before 1990 and 1% since 1990 (P = not significant). Long-term morbidity associated with the use of neurotoxic embolization materials is worrisome but has never been proven.

Cure, Morbidity, and Mortality Associated with Embolization of Brain Arteriovenous Malformations

Cure, Morbidity, and Mortality Associated with Embolization of Brain Arteriovenous Malformations

The Safety and Effectiveness of Brain Arteriovenous Malformation Embolization Using Acrylic and Particles

The purpose of this article is to report on the safety and effectiveness of brain arteriovenous malformation (AVM) embolization for two series of patients, of which one was treated with particulate embolization and the other with acrylic embolization. Sixty-five consecutive patients from embolization logs and patient records from 1988 to 1993 were reviewed. AVMs were routinely treated with particulate embolization early in the review (1988-1991), and after a transition period, the technique was changed to acrylic embolization for the remainder of the study period (1992-1993). All patients were treated with the ultimate goal of complete AVM obliteration. AVMs were embolized and resected, if possible, and if unresectable, they were reduced in size with embolization and radiated. The course of treatment for each patient was reviewed. The effectiveness at the end of treatment was analyzed for the ability to resect the AVM and, if unresectable, the ability to reduce the AVM to radiation size. Additionally, the safety of each embolization technique was evaluated in the context of comprehensive care, in terms of the safety of the procedure itself, the surgical resection after embolization, and the outcome at the end of comprehensive treatment. This article outlines the safety and effectiveness of acrylic and particulate embolization at a single institution. The ability to surgically resect an AVM after embolization and to reduce nidus size with acrylic was at least comparable with that with particulate embolization. Comprehensive complication rates were lower after acrylic embolization and were heavily influenced by a decreased number of surgical complications in the acrylic series. These data support the need to conduct a randomized prospective clinical trial to compare the relative safety and effectiveness of the two methods of embolization.

The Safety and Effectiveness of Brain Arteriovenous Malformation Embolization Using Acrylic and Particles

The Safety and Effectiveness of Brain Arteriovenous Malformation Embolization Using Acrylic and Particles

Newly Developed Materials and Techniques for Embolization of Brain Arteriovenous Malformations, Dural Arteriovenous Fistulae, and Aneurysms

Newly Developed Materials and Techniques for Embolization of Brain Arteriovenous Malformations, Dural Arteriovenous Fistulae, and Aneurysms

脳動静脈奇形治療における血管内手術の役割

Thirty-two patients were treated with embolization of brain arteriovenous malformations (AVM's). Of these patients, 16 underwent surgical removal of AVM and 16 radiosurgery following embolization. Embolization caused neurological deficit in six patients (morbidity 18%) and fatal brain swelling in one (mortality 3%). Complication occurred in 6 out of 17 patients with AVM's in the eloquent area (35%) and 1 out of 15 with those in the non-eloquent areas (6%). Although embolization was a valuable procedure in the treatment of brain AVM's combined with surgery or radiosurgery, indication for embolization of AVM should be carefully decided with consideration of therapeutic risk, especially for lesions in the eloquent areas.