Craniofacial Arteriovenous Malformation: Preoperative Embolization with Direct Puncture and Injection ofn-Butyl Cyanoacrylate

Abstract

Direct-puncture embolization with NBCA is an effective and safe technique for preoperative devascularization of craniofacial arteriovenous malformation. For safe and effective devascularization, compression of draining venous channels is thought to be important.

Embolization of High-Flow Craniofacial Vascular Malformations with Onyx

“…6 Others have used it successfully to attain total angiographic devascularization but still advocate surgical excision as the final step of treatment. 8 In some patients, endovascular treatment sufficed as the only treatment with durable clinical results. 9 We were able to find only 4 patients with CHVMs in the literature 10,11 where Onyx was used as a liquid embolic agent for endovascular treatment.…”

“…Another drawback of Onyx is the discomfort during injection in patients not treated under general anesthesia. 5 For the purpose of comparison with Onyx, it is important to note that some of the drawbacks of n-BCA classically encountered during embolization of cerebral AVMs are less significant or even advantageous for percutaneous approach, which has been the mainstay 8 of the embolization of CHVMs. First, the direct puncture approach eliminates the problem of catheter adhesion.…”

Direct-Puncture Embolization of Scalp Arteriovenous Fistulae

“…Fortunately, sAVFs are superficial lesions, and so direct puncture to the nidus and flow control by compression is possible. 7) The simplicity of the direct puncture protocol reduces the procedure time and eliminates the risk of microcatheter adhesion. Nonetheless, occlusion Neurol Med Chir (Tokyo) 52, July, 2012 S. W. Youn et al…”

“…6,8,13) Conventional surgery, which has been performed in the past to remove sAVFs or to ligate the feeding arterial pedicle, is associated with the risks of blood loss and recurrence from recruitment of a collateral supply. 11,14) Endovascular embolization via a transarterial or transvenous route, or via direct puncture, using N-butyl-2-cyanoacrylate (NBCA; Braun, Melsungen, Germany), 2,5,7) coils, 2,10,15) or Onyx (ev3, Plymouth, Minnesota, USA) 1) has been adopted as either a curative or preoperative option to improve these problems with surgery. However, the main technical problem of endovascular embolization is systemic migration of the embolic agents through the shunts, which is driven by both the venous outflow and arterial inflow.…”

“…However, the main technical problem of endovascular embolization is systemic migration of the embolic agents through the shunts, which is driven by both the venous outflow and arterial inflow. 3,9) Manual compression of the draining veins may be helpful, 7) but has limited effectiveness for the stasis of embolic material and involves increased exposure to the radiation field. Therefore, a compression device has been introduced to enable safe and effective embolization.…”