Embolization Of Cerebral Arteriovenous Malformations Research Articles

Intra-operative embolization of cerebral arteriovenous malformations by means of isobutylcyanoacrylate (experience in 20 cases).

20 cases of cerebral arteriovenous malformations (AVM's) are reported, treated by direct intraoperative embolization. A 50% mixture of butyl-2-cyanoacrylate (IBC) and ethyl mono-iodostearate (Duroliopaque) was used. The clinical history of the patients was a long history of seizures in 10 cases, a haemorrhage in 9 cases, and a motor deficit in 1 case. In the immediate post-operative course, 1 patient died, 3 patients had a serious post-operative haemorrhage, 6 patients presented with a transient post-operative deficit, and in 10 patients the post-operative course was uneventful. During the following years, a late haemorrhage occurred after incomplete AVM eradication in 3 patients, leading to AVM resection. The AVM eradication was eventually complete in 3 cases with embolization only, and in 7 cases with embolization and AVM resection. The overall management of AVM in all 20 patients was: embolization only in 13 cases, embolization and resection in 7 cases. The long term results are: operative death 1, late death 3, long lasting deficit 1; uneventful 15. The authors discuss the technique of embolization, the effect of IBC on the vessel walls, the evolution of their general management of AVM's after this experience. Eventually the intra-operative embolization may be helpful after incomplete intra vascular embolization, to facilitate the AVM eradication.

Experience with bucrylate (isobutyl-2-cyanoacrylate) embolization of cerebral arteriovenous malformations during surgery

The clinical experience with five patients selected for embolization of cerebral arteriovenous malformations with bucrylate (isobutyl-2-cyanoacrylate) during surgery is described. Bucrylate embolization was used to obliterate one arteriovenous malformation with a dominant nutrient arterial network, and to facilitate surgical resection in two other cases. The extent of the embolization in one of these cases was limited because of segmental perfusion of the AVM nidus by different nutrient arteries. Histological examination of this arteriovenous malformation, resected 56 days after embolization, suggested bucrylate has minimal histotoxicity. Two arteriovenous malformations were found at operation to be unsuitable for embolization because of technical problems with access and exposure of nutrient arteries, and also because of vagaries in the angiographic data before surgery. In two cases, rapid polymerization of bucrylate resulted in gluing of the injection catheters into the arterial lumen. Two patients experienced transient postoperative neurological deficits after bucrylate embolization. Because of the potential hazards of the technique, direct bucrylate embolization of cerebral arteriovenous malformations should only be considered for those lesions felt unsuitable for direct microsurgical excision, and where facilities exist for recording angiographic data before surgery.

Factors Governing the Course of Emboli in the Therapeutic Embolization of Cerebral Arteriovenous Malformations

Many factors are involved in the therapeutic intra-arterial management of cerebral arteriovenous malformations (AVMs) by embolization. If these factors could be better defined, the suitability of patients for embolization could be more accurately predicted. In 59 embolization procedures, the diameters of feeding arteries of AVMs were analyzed, and a critical diameter found below which emboli are likely to stray into normal vessels and above which embolization can be carried out with a greater chance of success. Neurologic complications occurred on 20 occasions, but most were temporary; in only 1 of 34 patients did a permanent incapacitating complication occur.

Surgical embolization of cerebral arteriovenous malformations through internal carotid and vertebral arteries. Long-term results.

The authors describe the clinical results of surgical embolization in 55 patients with large cerebral arteriovenous malformations. Follow-up intervals ranged from 2 months to 14 years, averaging 4 1/2 years. The authors believe the procedure is safe in properly selected patients and is useful as a preliminary to direct surgical excision. It relieves associated headaches, and usually reverses or stabilizes a progressive neurological deficit. The potential for seizures probably is not altered. The incidence of hemorrhage following embolization is low for patients with no previous history of hemorrhage; however, the procedure does not reduce the likelihood of recurrence in patients with a prior history of hemorrhage.

Electronic radiography in stereotaxic thrombosis of intracranial aneurysms and catheter embolization of cerebral arteriovenous malformations.

An electronic radiographic technique which utilizes a television fluoroscopic system coupled with a disc recorder is described. Images from this system can be combined with live fluoroscopic images, allowing rapid and accurate catheterization of intracerebral arteries in embolization of cerebral artery arteriovenous malformations. This procedure can also be used in stereotaxic transcerebral thrombosis of intracranial aneurysms by injection with tissue adhesive. This system gives lower radiation dosage to patient and operator, decreases procedure time, and allows instantaneous retrieval of information.