Target Embolization of AVMs: Identification of Sites and Results of Treatment

Abstract

<jats:p> Although cure of cerebral arteriovenous malformations (AVMs) is the ideal goal it is often only possible with smaller sized lesions. This is certainly true if surgery or radiotherapy is used as the treatment strategy. Endovascular treatment, however, allows the possibility of partial treatment directed at specific areas of AVM architecture. With this in mind we retrospectively reviewed our cohort of AVMs to establish which morphological areas we had identified as targets and how the treatment of the AVM influenced the clinical picture. </jats:p><jats:p> Over a 36-month period 42 AVMs were treated. In 22 of the patients who presented with a hemorrhage an intranidal aneurysm was identified as a target and treated in nine patients. </jats:p><jats:p> Other patients presented with headaches (2), neurological deficit (4) and seizures (16) with two patients having their AVM picked up coincidentally. Targets identified included high flow fistulas (12), decreasing venous flow (17) and cure of the AVM (8). </jats:p><jats:p> Results of targeted treatment showed a lower rehemorrhage rate than anticipated by the natural history. Patients cured did best and targeted embolization improved seizures in nine patients, neurological deficit in four patients and headache in 20 patients. </jats:p><jats:p> Until safer methods exist to cure large AVMs the use of targeted embolization is acceptable as it protects patients against rehemorrhage and translates into an improvement in their clinical picture. </jats:p>

The Results of Invasive Treatment of Patients With Brain Arteriovenous Malformations With Seizure

“…Метод эндоваскулярной эмболизации оказался эффективным в лечении пациентов с АВМ и структурной эпилепсией. Совершенствование технологии внутрисосудистых вмешательств показывает значительное улучшение результатов в отношении сокращения периоперационных осложнений с высокой радикальностью выключения АВМ [19,20,25,27] Нами получены хорошие результаты лечения пациентов с эпилептическим типом течения АВМ головного мозга в отношении контроля над эпилептическими приступами после комбинированной инвазивной терапии. Радикальность выключения АВМ имела статистическую значимость для свободы от приступов: тотальное выключение позволяла обеспечить лучший контроль над приступами в сравнении с парциальной эмболизацией.…”

Endovascular and microsurgical treatment of cerebral arteriovenous malformations: Current recommendations

“…If a high-grade AVM is not considered safe for any type of curative treatment, embolization may serve as a way to decrease rupture risk by treating specific features associated with hemorrhage such as nidal aneurysms or venous ectasia. [ 19 23 25 ] Additionally, embolization may be used for the reduction of AV shunting through the lesion, improving or resolving a neurologic deficit attributable to vascular steal. [ 4 11 20 24 ] The potential benefits of this type of palliative embolization must be weighed against the published evidence of increased hemorrhage risk from incompletely treated AVMs.…”

“…Embolization prior to stereotactic radiosurgery has been performed as a way of decreasing the size of the nidus and thus the requisite radiation dose. [ 19 23 ] However, the published outcomes regarding this treatment protocol have been mixed. [ 3 6 15 38 39 ] Although the lower radiation dose decreases the risk to the surrounding normal tissue, several studies have reported a lower rate of obliteration following such a regimen without any decrease in the risk of hemorrhage during the latency period.…”

Cerebral Arteriovenous Malformation Diagnosis and Management

“…When combined with radiosurgery, the target of embolization is often the periphery of the AVM to reduce the size and therefore the total radiation dose required. 61,62 Clinically significant complications have been reported to occur in $ 6.5% cases. 63…”