Aims and objectives
Evaluation of endovascular treatment of cerebral arteriovenous malformations (cAVMs) prior to surgical resection.
Methods and materials
Cerebral arteriovenous malformations (cAVM) are high risk vascular lesions that are difficult to treat.
If possible,
combined (endovascular and (radio-)surgical) approaches to completely remove the cAVM is advocated.
From 2010 until 2013,
19 cAVMs in 19 patients (11 female,
8male; mean/median age 35 years (range 11-57)) were treated in our hospital by endovascular occlusion followed by surgical resection.
Presentation of the patients: epilepsy (n=8),
bleeding (n=6),
neurological deficit (n=2),
haedaches (n=1),andincidental finding (n=2).
The cAVMs were located inperipheral,
surgically resectablebrain locations in the cerebral hemispheres...
Results
Preoperative staged endovascular occlusion with Onyx® to reduce the cAVM was performed in 48 embolisations with a mean of 2,6 embolisations per patient (range 1 - 8).
Three flowaneurysms were coiled,
one was clipped and one was not treated.
Infour patients complications occurred (21%).Three patients had perprocedural endovascular complications (6%): neurological deficit (1),
haemorrhage (1) and thrombo-embolism (1).
These complications resulted finally inno patients with permanent neurological deficit.
One patient bled from the cAVM during surgery resulting in permanent neurological deficit.
Overall morbidity of 16%,...
Conclusion
Preoperative endovascular occlusion of cAVMs prior to neurosurgical resection is a delicate procedure.
In selected cases this combined technique can completely cure patients from a potential high risk vascular lesion with a relatively low complication rate.
Personal information
prof dr Maurits HJ Voormolen
Interventional Neuroradiology
Antwerp University Hospital
department of Radiology
Wilrijkstraat 10
2650 Edegem
Belgium
e-mail:
[email protected]
References
Spetzler RF,
Martin NA.
A proposed grading system for arteriovenous malformations. J Neurosurg.
1986 Oct;65(4):476-83
Viñuela F,
Dion JE,
Duckwiler G,
Martin NA,
Lylyk P,
Fox A,
Pelz D,
et al.
Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases. J Neurosurg.
1991 Dec;75(6):856-64
Taylor CL,
Dutton K,
Rappard G,
Pride GL,
Replogle R,
Purdy PD,
et al.
Complications of preoperative embolization of cerebral arteriovenous malformations. J Neurosurg.
2004 May;100(5):810-2
van Rooij WJ,
Sluzewski M,
Beute GN.
Brain...
