Nidal embolization of brain arteriovenous malformations: rates of cure, partial embolization, and clinical outcome

Sahlein, Daniel; Mora, Paloma; Becske, Tibor; Nelson, Peter Kim

doi:10.3171/2012.3.jns111405

Cited by 45 publications

(34 citation statements)

References 22 publications

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“…28 As noted above, this is not the first article to find that bAVMs with 1 draining vein are more likely to present with hemorrhage. 4,7,23,24 However, it is the first to test the physiological meaning of single venous drainage using different groups of bAVMs defined by unique sets of outflow conditions.…”

Section: Discussionmentioning

confidence: 91%

“…In this study, we examine detailed bAVM angioarchitectural features and their association with hemorrhagic presentation using a retrospective case series of all bAVMs embolized at our medical center between 1997 and 2006, 28 in much the same way that other studies have done previously. In addition, we attempt to clarify the potential physiological significance of the factors associated with hemorrhagic presentation.…”

mentioning

confidence: 99%

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Features Predictive of Brain Arteriovenous Malformation Hemorrhage

Sahlein

Mora

Becske

et al. 2014

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Background and Purpose-Although there is generally thought to be a 2% to 4% per annum rupture risk for brain arteriovenous malformations (bAVMs), there is no way to estimate risk for an individual patient. Methods-In this retrospective study, patients were eligible who had nidiform bAVMs and underwent detailed pretreatment diagnostic cerebral angiography at our medical center from 1996 to 2006. All patients had superselective microcatheter angiography, and films were reviewed for the purpose of this project. Patient demographics, clinical presentation, and angioarchitectural characteristics were analyzed. A univariate analysis was performed, and angioarchitectural features with potential physiological significance that showed at least a trend toward significance were added to a multivariate logistic regression model. Results-One hundred twenty-two bAVMs met criteria for study entry. bAVMs with single venous drainage anatomy were more likely to present with hemorrhage. In addition, patients with multiple draining veins and a venous stenosis reverted to a risk similar to those with 1 draining vein, whereas those with multiple draining veins and without stenosis had diminished association with hemorrhage presentation. Those bAVMs with associated aneurysms were more likely to present with hemorrhage. These findings were robust in both univariate and multivariate models. Conclusions-The

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Section: Discussionmentioning

confidence: 91%

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confidence: 99%

Features Predictive of Brain Arteriovenous Malformation Hemorrhage

Sahlein

Mora

Becske

et al. 2014

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“…Generally, this complication may not cause disastrous consequences. With the advent of Onyx and growing experience in embolization of cerebral arteriovenous malformations, the non-adhesive liquid embolic agent has been rapidly replacing the use of acrylic glue [1][2][3][12][13][14] . Unlike NBCA or Glubran 2, Onyx injection requires more fluoroscopy and procedure times, and it is a controllable embolic agent 15 .…”

Section: Embolization Resultsmentioning

confidence: 99%

Curative Glubran 2 Embolization of Cerebral Arteriovenous Malformations Patient Selection and Initial Results

Liu

et al. 2014

Interv Neuroradiol

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The liquid embolic agents currently used for embolization of cerebral arteriovenous malformations are Onyx and NBCA. Glubran 2, a cyanoacrylate-based synthetic glue, has recently been applied for embolization of cerebral arteriovenous malformations (AVMs). We report the clinical results of selected cerebral AVMs treated with Glubran 2 targeting for curative embolization. Between October 2011 and March 2013, 31 patients with cerebral AVMs were selected for curative embolization with Glubran 2. There were 19 men and 12 women with a mean age of 32 years (range 4–65 years). Initial clinical presentation included hemorrhage in 28 and seizures in three patients. AVM location was frontal in eight patients, parietal in four, occipital in eight temporal in six, cerebellar in two and cerebellar vermis in three patients. Follow-up was performed clinically and with angiography examination at three to six months. Clinical outcomes were evaluated based on the modified Rankin Scale (mRS). A mean of 2.5 (range, 1–12) feeding pedicles were embolized per patient. Complete angiographic obliteration of AVM was achieved in 27 patients. A hemorrhagic complication was observed in one patient, an ischemic complication in one patient and technical complications in four patients. There was no procedure-related disabling neurological deficit or death at discharge. Additional gamma knife radiosurgery was performed in five patients, including one patient with recurrent AVM. All of the patients had favorable clinical outcomes at three to six month follow-up (mRS≤2). The curative embolization technique with Glubran 2 for selected cerebral AVMs achieved a high initial complete obliteration rate with an acceptable complication frequency.

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“…Such an approach has been validated in the literature although controversy exists, with some practitioners favoring single-staged embolization. 44,45 …”

Section: Premicrosurgical Embolizationmentioning

confidence: 99%