Results of surgical and endovascular treatment of intracranial micro-arteriovenous malformations with emphasis on superselective angiography

Perrini, P.; Scollato, Antonio; Cellerini, M.; Mangiafico, Salvatore; Ammannati, Franco; Mennonna, P; Lorenzo, Nicola Di

doi:10.1007/s00701-004-0268-6

Cited by 22 publications

(27 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both Fournier et al and Strauss et al have associated low Spetzler-Martin grades with complete embolization. 14,60 This finding is consistent with the fact that both small size 5,9,48,49,54,72 and noneloquent location 60 have also been associated with complete AVM embolization.…”

Section: Spetzler-martin Gradesupporting

confidence: 90%

See 1 more Smart Citation

Curing arteriovenous malformations using embolization

Potts

Zumofen

Raz

et al. 2014

FOC

View full text Add to dashboard Cite

Endovascular embolization is typically reserved as an adjuvant therapy in the management of cerebral arteriovenous malformations (AVMs), either for preoperative devascularization or preradiosurgical volume reduction. Curative embolization plays a limited role in AVM treatment but several studies have shown that it is possible, especially with later-generation liquid embolic agents. Given the complexity of AVM anatomy and the recent controversies over the role of any intervention in AVM management, it is critical that the cerebrovascular community better define the indications of each treatment modality to provide quality AVM management. In this review, the authors evaluate the role of curative AVM embolization. Important considerations in the feasibility of curative AVM embolization include whether it can be performed reliably and safely, and whether it is a durable cure. Studies over the past 20 years have begun to define the anatomical factors that are amenable to complete endovascular occlusion, including size, feeding artery anatomy, AVM morphology, and endovascular accessibility. More recent studies have shown that highly selected patients with AVMs can be treated with curative intent, leading to occlusion rates as high as 100% of such prospectively identified lesions with minimal morbidity. Advances in endovascular technology and techniques that support the efficacy and safety of curative embolization are discussed, as is the importance of superselective diagnostic angiography. Finally, the durability of curative embolization is analyzed. Overall, while still unproven, endovascular embolization has the potential to be a safe, effective, and durable curative treatment for select AVMs, broadening the armamentarium with which one can treat this disease.

show abstract

Section: Spetzler-martin Gradesupporting

confidence: 90%

“…49 72 Similarly, studies reporting embolization of micro-AVMs (defined as nidus diameter < 1 cm) have also shown excellent cure rates. 5,48 Anatomically, small AVM size may equate to a less complex AVM with fewer feeders. Small size, however, is not universally acknowledged as a positive predictive factor for the success of AVM embolization.…”

Section: Avm Sizementioning

confidence: 99%

Curing arteriovenous malformations using embolization

Potts

Zumofen

Raz

et al. 2014

FOC

View full text Add to dashboard Cite

show abstract

“…Our endovascular complication rate is comparable with the 12-22% hemorrhagic complications reported by Andreou et al and Perrini et al [13,15]. Others have merely reported the absence of neurological complications [4,14], which is also similar to our results.…”

Section: Discussionsupporting

confidence: 82%

“…Liquid embolic agents used in our series were ONYX in 4 procedures (1 successful) and nBCA in 2 (1 successful). All previous studies reporting embolization results of micro-AVMs used nBCA [13][14][15]. The safety and effectiveness of both agents in preoperative adjunct treatments, have been compared in a single randomized controlled trial including larger AVMs [16], but they have not been compared directly in achieving successful obliteration to date.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Intracranial Superfi cial Micro-AVMs: A Single Center Experience

Overdevest¹,

Es²,

Walderveen³

et al. 2017

J Neurol Neurol Sci Disord

View full text Add to dashboard Cite

Background: Surgery and embolization may both be considered in ruptured superfi cial micro-AVMs. However, surgery may be challenged by poor recognition of the lesion and embolization by diffi culty in achieving complete obliteration and avoiding en passage feeders. Recent developments in AVM surgery and embolization techniques call for a reevaluation of these treatment options.Methods: Eight consecutive patients with superfi cial micro-AVMs are presented. All patients received an initial embolization attempt with either nBCA or ONYX. If complete obliteration was not obtained, either a second embolization or surgical resection was offered. At surgery, indocyanine green video angiography (ICG-VA) was used in all cases. Effectiveness and safety of all procedures were evaluated retrospectively. Functional outcome at 6 months was assessed by the modifi ed Ranking Score (mRS).Results: Patients had a mean age of 52±17 years and all presented with hemorrhage. The mean nidus size was 4 mm, and was localized supratentorially in 5 cases and infratentorially in 3. Initial embolization was successful in 2 patients (25%). One patient underwent a second, unsuccessful, embolization attempt and 1 patient did not receive further treatment. Consequently, fi ve patients underwent surgery, which was successful in four (80%). The unsuccessful case was successfully reoperated. The only two procedural complications were related to superselective embolization, but neither caused clinical sequelae. Mean clinical follow-up was 29 months (range, 4-75mo), with mRS 0 in 2, mRS 1 in 4 and mRS 3 in 2 cases. Conclusions:In a current case series, embolization of superfi cial micro-AVMs was associated with a lower success rate (25% vs 80%) than microsurgery and a higher procedural complication rate (minor complications: 22% vs 0%).

show abstract

“…Embolization of AVMs is typically used to reduce nidal size in advance of surgical resection or radiosurgery. [1][2][3][4][5][6][7][8] Embolization can also be used to reduce hemorrhage risk by attempting to eliminate specific areas at high risk for hemorrhage such as intranidal aneurysms, 9 or less commonly, by attempting to completely obliterate the nidus. Recent advances in the embolization technique during the past decade include the development of softer flow-directed microcatheters and the increased use of liquid embolic agents, including cyanoacrylate derivatives to assure nidal penetration during embolization.…”

mentioning

confidence: 99%