Deep central arteriovenous malformations of the brain: the role of endovascular treatment

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✓ Cerebral deep central arteriovenous malformations (AVMs) are uncommon lesions associated with considerable difficulty in treatment. The authors report a series of 14 deep central AVMs treated by endovascular methods and examine the present role of endovascular treatment. This treatment used alone resulted in complete obliteration of AVMs in approximately 15% of cases and reduction in 50% to a size permitting treatment by means of radiosurgery. Reversal of previous neurological signs and symptoms occurred in 35.7% of embolized patients. Overall, nearly 80% of patients had either complete obliteration of the lesion, reduction to a size allowing radiosurgical treatment, or reversal of previous neurological deficits. There were treatment complications in 14.3% of the cases. Endovascular treatment methods may make a significant contribution to the therapy of AVMs that have a particularly poor course and are difficult to treat by other means.

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Address reprint requests to: Robert W. Hurst, M.D., Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.

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Figures

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    Angiograms demonstrating a large arteriovenous malformation (AVM) receiving its arterial supply from both the anterior and posterior portions of the circle of Willis. A and B: Preoperative anteroposterior (A) and lateral (B) left carotid injections. C and D: Anteroposterior (C) and lateral (D) left vertebral injections demonstrating involvement of the right thalamus with extension into the medial parietooccipital region. E and F: Postembolization views of right internal carotid (E) and left vertebral (F) show residual AVM prior to radiosurgery.

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    Angiograms in two cases revealing intranidal aneurysms. Left: Lateral left vertebral injection demonstrates posterior thalamic arteriovenous malformation (AVM) supplied by posterior choroidal arteries. Center: Selective injection of left posterior choroidal artery shows nidus with intranidal aneurysms and deep venous drainage. Right: Postembolization left vertebral injection reveals complete obliteration of AVM.

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    Late-sequence angiograms evaluating venous drainage. Lateral early- (left) and late- (center) phase vertebral injections demonstrating arteriovenous malformation with drainage into the vein of Galen. Postembolization film (right) revealing considerable decrease in arteriovenous shunting.

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