ORIGINAL PAPER
Endovascular treatment of small cerebral arteriovenous malformations as a primary therapy
 
More details
Hide details
 
Submission date: 2018-02-02
 
 
Final revision date: 2018-02-13
 
 
Acceptance date: 2018-02-23
 
 
Publication date: 2018-06-22
 
 
Pol J Radiol, 2018; 83: 143-149
 
KEYWORDS
TOPICS
ABSTRACT
Purpose:
The patient population that would benefit most from endovascular curative treatment of intracranial arteriovenous malformations has not been clearly established. The aim of the study was to determine the effect of curative embolisation of cerebral arteriovenous malformations with special regard to radiographic and clinical outcomes and procedure-related complications

Material and methods:
Between January 2009 and December 2014, 18 patients with intracranial arteriovenous malformations were embolised with Onyx with intent to cure. There were four women and 14 men, with a mean age of 40 years (range 10-62 years). Inclusion criteria were: maximal diameter of the lesions ≤ 3 cm and arterial supply consisting of no more than two major arteries. Five (27.8%) patients had ruptured lesions, and 13 (72.2%) patients had unruptured lesions. Mean arteriovenous malformation size was 2.3 cm (range 1.5-2.9 cm).

Results:
Thirty-three procedures were performed in 18 patients. Total obliteration was achieved in five patients (27.8%). The most common reason for initial incomplete angiographic occlusion was unfavourable angioarchitectural features of arteriovenous malformations, with the rate of 44.4%. The mean follow-up of patients with complete occlusion was 35.2 months (range 18-60 months). Complication rate was 12.1%. One patient had permanent neurological deficit with resulting morbidity of 5.6%. There were no deaths.

Conclusions:
Embolisation of intracranial arteriovenous malformations plays a limited role as a sole therapeutic modality even in terms of small lesions with two or fewer arterial feeders, although larger prospective series are necessary to confirm these findings. Associated complications are not trivial and should be considered when choosing this form of treatment.

 
REFERENCES (23)
1.
Cohen-Gadol A, Conger A, Kulwin C, et al. Endovascular and micro­surgical treatment of cerebral arteriovenous malformations: Current recommendations. Surg Neurol Int 2015; 6: 39.
 
2.
Bruno CA, Meyers PM. Endovascular Management of Arteriovenous Malformations of the Brain. Interv Neurol 2013; 1: 109-123.
 
3.
Ogilvy CS, Stieg PE, Awad I, et al. AHA Scientific Statement: Recommendations for the management of intracranial arteriovenous malformations: a statement for healthcare professionals from a special writing group of the Stroke Council, American Stroke Association. Stroke 2001; 32: 1458-1471.
 
4.
van Rooij WJ, Sluzewski M, Beute GN. Brain AVM embolization with Onyx. AJNR Am J Neuroradiol 2007; 28: 172-177; discussion 178.
 
5.
Guo WY, Wikholm G, Karlsson B, et al. Combined embolization and gamma knife radiosurgery for cerebral arteriovenous malformations. Acta Radiol 1993; 34: 600-606.
 
6.
Potts MB, Zumofen DW, Raz E, et al. Curing arteriovenous malformations using embolization. Neurosurg Focus 2014; 37: E19.
 
7.
Debrun G, Vinuela F, Fox A, et al. Embolization of cerebral arteriovenous malformations with bucrylate. J Neurosurg 1982; 56: 615-627.
 
8.
Fournier D, TerBrugge KG, Willinsky R et al. Endovascular treatment of intracerebral arteriovenous malformations: experience in 49 cases. J Neurosurg 1991; 75: 228-233.
 
9.
Katsaridis V, Papagiannaki C, Aimar E. Curative embolization of cerebral arteriovenous malformations (AVMs) with Onyx in 101 patients. Neuroradiology 2008; 50: 589-597.
 
10.
Yu SCH, Chan MSY, Lam JMK, et al. Complete obliteration of intracranial arteriovenous malformation with endovascular cyanoacrylate embolization: initial success and rate of permanent cure. AJNR Am J Neuroradiol 2004; 25: 1139-1143.
 
11.
Xu F, Ni W, Liao Y, et al. Onyx embolization for the treatment of brain arteriovenous malformations. Acta Neurochir (Wien) 2011; 153: 869-878.
 
12.
Sahlein DH, Mora P, Becske T, et al. Nidal embolization of brain arteriovenous malformations: rates of cure, partial embolization, and clinical outcome. J Neurosurg 2012; 117: 65-77.
 
13.
Pierot L, Cognard C, Herbreteau D, et al. Endovascular treatment of brain arteriovenous malformations using a liquid embolic agent: results of a prospective, multicentre study (BRAVO). Eur Radiol 2013; 23: 2838-2845.
 
14.
Willinsky R, Goyal M, Terbrugge K, et al. Embolisation of Small (< 3 cm) Brain Arteriovenous Malformations. Correlation of Angiographic Results to a Proposed Angioarchitecture Grading System. Interv Neuroradiol J Peritherapeutic Neuroradiol Surg Proced Relat Neurosci 2001; 7: 19-27.
 
15.
Valavanis A, Christoforidis G. Endovascular management of cerebral arteriovenous malformations. Neurointerventionist 1999; 1: 34-40.
 
16.
Abdulrauf SI, Malik GM, Awad IA. Spontaneous angiographic obliteration of cerebral arteriovenous malformations. Neurosurgery 1999; 44: 280-287; discussion 287-288.
 
17.
Patel MC, Hodgson TJ, Kemeny AA, et al. Spontaneous obliteration of pial arteriovenous malformations: a review of 27 cases. AJNR Am J Neuroradiol 2001; 22: 531-536.
 
18.
Vińuela F, Fox AJ, Debrun G, et al. Progressive thrombosis of brain arteriovenous malformations after embolization with isobutyl 2-cyano­acrylate. AJNR Am J Neuroradiol 1983; 4: 1233-1238.
 
19.
Bendok BR, Getch CC, Ali MJ, et al. Spontaneous thrombosis of a residual arteriovenous malformation in eloquent cortex after surgery: case report. Neurosurgery 2002; 50: 1142-1145; discussion 1145-1146.
 
20.
Berthelsen B, Löfgren J, Svendsen P. Embolization of cerebral arteriovenous malformations with bucrylate. Experience in a first series of 29 patients. Acta Radiol 1990; 31: 13-21.
 
21.
Arteriovenous Malformations. In: Harrigan MR, Deveikis JP, eds. Handbook of Cerebrovascular Disease and Neurointerventional Technique [Internet]. Humana Press, Totowa 2009 [cited 2016 Mar 14]. Available from: http://link.springer.com/10.10....
 
22.
Mounayer C, Hammami N, Piotin M et al. Nidal embolization of brain arteriovenous malformations using Onyx in 94 patients. AJNR Am J Neuroradiol 2007; 28: 518-523.
 
23.
Spetzler RF, Martin NA, Carter LP et al. Surgical management of large AVM’s by staged embolization and operative excision. J Neurosurg 1987; 67: 17-28.
 
Journals System - logo
Scroll to top