Intra-arterial Embolization in the Treatment of Brain Arteriovenous Malformations

Abstract

The crucial question - treat or not a brain arteriovenous malformation - has been the object of many studies, sometimes contradictory. The authors analyse retrospectively, clinically and angiographically, the results of the intra-arterial embolization in the treatment of 106 patients with brain arteriovenous malformation. The endovascular therapy was palliative or curative in 46% of the cases, in 30% of the patients the embolization was pre-surgery and in 18% the intra-arterial occlusion was pre-radiosurgery. In 6% the therapeutic protocol included embolization with surgery and radiosurgery. Cyanocrylate was used in 89% of the cases, and in 10% of the patients the embolic material used was Ethylene - vinyl alcohol copolymer - EVOH (Onyx). In this series 11% of total morbidity occurred - transitory in 8% and settled with permanent neurological deficit in 3% of the patients. The mortality post-embolization was 2% and the total mortality post-embolization and surgery was 3%. Total angiographic exclusion immediately post-embolization was confirmed in 24% of the cases. The mean period for clinical and angiographic follow-up was 38 months. 72 patients - 77% of the cases discharged from hospital showed complete exclusion of the lesion after the different combined therapeutic strategy - embolization, surgery and radiosurgery. New retrospective and long-term prospective studies based on the actual therapeutic protocols and new embolic agents are necessary to be able to evaluate accurately a new therapeutic reality in the brain arteriovenous malformations.