Endovascular Treatment of Cerebral Arteriovenous Malformations

Yakovlev S., Bocharov ., Arustamyan S., Bukharin ., Lisachev .

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

The research goal was to estimate efficacy of endovascular embolization of cerebral arteriovenous malformations (AVM).

Material and Methods. There were 525 cases with cerebral AVM, treated in 1996-2005. Their age varied from 4 months up to 67 years. A number of males and females was 289 and 236 respectively. Clinical manifestations of AVM were as follows: intracranial hemorrhages (ICH) - 23%, symptomatic epilepsy (SE) - 48.5%, ICH and SE - 12%, headache - 13%, neurological deficit - 3.5%. There were 489 cases (93.1%) with supratentorial AVM and 36 patients (6.9%) with infratentorial AVM. Two-thirds of AVM were radically inoperable. Catheterization was carried out with Magic 1.2-1.8F microcatheters. Embolization was preceded by pharmacologic tests. The Histoacryl : Lipiodol glue composition was used for embolization. When there were direct arteriovenous fistulas, shunt occlusion was achieved by using microcoils and balloons (Balt, France).

Results and Discussion. Total, subtotal and partial exclusion of AVM was achieved in 24%, 31% and 45% of cases respectively. There were the following perioperative complications: intracranial hemorrhages - 8 cases (1.5%) with formation of intracerebral hematomas in 4 of them; parenchymal and intraventricular hemorrhages - 4 cases; ischemic disorders, the half of which was transient - 12 (2.3%). The rates of postoperative mortality and disability were 0.76% and 3% respectively. A follow-up period (150 cases) lasted 1-5 years. Three cases died of repeated intracranial hemorrhages. As for outcomes, watched in the rest patients, they were represented by clinical stabilization (86), improvement (45), no changes (12) and aggravation (4).

Conclusions. Embolization is a method of choice in treatment of radically inoperable cerebral AVM. Besides, it can be combined with radiosurgery and recommended as the first stage of multimodality treatment.