Complications of preoperative embolization of cerebral arteriovenous malformations

View More View Less
  • 1 Department of Neurological Surgery and Department of Radiology, The University of Southwestern Texas Medical Center, Dallas, Texas
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object. Preoperative embolization is viewed by the authors as a useful adjunct in the surgical management of cerebral arteriovenous malformations (AVMs). This study was performed to determine the rate of significant complication in patients undergoing this procedure.

Methods. Demographic, anatomical, and procedure data were collected prospectively. The treating physician reported complications. In addition, a review of medical records including procedure reports, operative reports, and discharge summaries was performed. Univariate statistical analysis was performed to determine if any of the variables was predictive of a poor outcome of embolization (death or permanent neurological deficit).

Endovascular procedures for embolization were performed 339 times in 201 patients during an 11-year period. Female patients comprised 53.7% of the study group and 85.6% of the AVMs were supratentorial. Embolization was performed using polyvinyl alcohol particles, N-butyl cyanoacrylate, detachable coils, and/or the liquid polymer Onyx. Analyzed by procedure, a poor result of embolization occurred in 7.7%. Analyzed by patient, 11% died or had a permanent neurological deficit as a result of the embolization. None of the demographic, anatomical, or procedure variables identified were predictive of a poor outcome.

Conclusions. Preoperative embolization may gradually reduce flow to an AVM, reduce intraoperative blood loss, and reduce operative time. The risks of this procedure, however, are not insignificant and must be considered in planning treatment for patients with AVMs.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Christopher L. Taylor, M.D., Department of Neurological Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390–8855. email: christopher.taylor@utsouthwestern.edu.
  • 1.

    Dowd CF, , Halbach VV, & Barnwell SL, et al: Particulate embolization of the anterior choroidal artery in the treatment of cerebral arteriovenous malformations. AJNR 12:10551061, 1991 Dowd CF, Halbach VV, Barnwell SL, et al: Particulate embolization of the anterior choroidal artery in the treatment of cerebral arteriovenous malformations. AJNR 12:1055–1061, 1991

    • Search Google Scholar
    • Export Citation
  • 2.

    Horowitz MB, , Dutton K, & Purdy PD: Assessment of complication types and rates related to diagnostic angiography and interventional neuroradiologic procedures: a four year review (1993–1996). Intervent Neuroradiol 4:2737, 1998 Horowitz MB, Dutton K, Purdy PD: Assessment of complication types and rates related to diagnostic angiography and interventional neuroradiologic procedures: a four year review (1993–1996). Intervent Neuroradiol 4:27–37, 1998

    • Search Google Scholar
    • Export Citation
  • 3.

    Jahan R, , Murayama Y, & Gobin YP, et al: Embolization of arteriovenous malformations with Onyx: clinicopathological experience in 23 patients. Neurosurgery 48:984997, 2001 Jahan R, Murayama Y, Gobin YP, et al: Embolization of arteriovenous malformations with Onyx: clinicopathological experience in 23 patients. Neurosurgery 48:984–997, 2001

    • Search Google Scholar
    • Export Citation
  • 4.

    Liu HM, , Huang YC, & Wang YH: Embolization of cerebral arteriovenous malformations with n-butyl-2—cyanoacrylate. J Formos Med Assoc 99:906913, 2000 Liu HM, Huang YC, Wang YH: Embolization of cerebral arteriovenous malformations with n-butyl-2—cyanoacrylate. J Formos Med Assoc 99:906–913, 2000

    • Search Google Scholar
    • Export Citation
  • 5.

    Meisel HJ, , Mansmann U, & Alvarez H, et al: Effect of partial targeted N-butyl-cyano-acrylate embolization in brain AVM. Acta Neurochir 144:879888, 2002 Meisel HJ, Mansmann U, Alvarez H, et al: Effect of partial targeted N-butyl-cyano-acrylate embolization in brain AVM. Acta Neurochir 144:879–888, 2002

    • Search Google Scholar
    • Export Citation
  • 6.

    Nakstad PH, & Nornes H: Superselective angiography, embolization and surgery in treatment of arteriovenous malformations of the brain. Neuroradiology 36:410413, 1994 Nakstad PH, Nornes H: Superselective angiography, embolization and surgery in treatment of arteriovenous malformations of the brain. Neuroradiology 36:410–413, 1994

    • Search Google Scholar
    • Export Citation
  • 7.

    The N-BCA Trial Investigators: n-Butyl cyanoacrylate embolization of cerebral arteriovenous malformations: results of a prospective, randomized, multi-center trial. AJNR 23:748755, 2002 The N-BCA Trial Investigators: n-Butyl cyanoacrylate embolization of cerebral arteriovenous malformations: results of a prospective, randomized, multi-center trial. AJNR 23:748–755, 2002

    • Search Google Scholar
    • Export Citation
  • 8.

    Song JK, , Eskridge JM, & Chung EC, et al: Preoperative embolization of cerebral arteriovenous malformations with silk sutures: analysis and clinical correlation of complications revealed on computerized tomography scanning. J Neurosurg 92:955960, 2000 Song JK, Eskridge JM, Chung EC, et al: Preoperative embolization of cerebral arteriovenous malformations with silk sutures: analysis and clinical correlation of complications revealed on computerized tomography scanning. J Neurosurg 92:955–960, 2000

    • Search Google Scholar
    • Export Citation
  • 9.

    Sorimachi T, , Koike T, & Takeuchi S, et al: Embolization of cerebral arteriovenous malformations achieved with polyvinyl alcohol particles: angiographic reappearance and complications. AJNR 20:13231328, 1999 Sorimachi T, Koike T, Takeuchi S, et al: Embolization of cerebral arteriovenous malformations achieved with polyvinyl alcohol particles: angiographic reappearance and complications. AJNR 20:1323–1328, 1999

    • Search Google Scholar
    • Export Citation
  • 10.

    Wallace RC, , Flom RA, & Khayata MH, et al: The safety and effectiveness of brain arteriovenous malformation embolization using acrylic and particles: the experiences of a single institution. Neurosurgery 37:606618, 1995 Wallace RC, Flom RA, Khayata MH, et al: The safety and effectiveness of brain arteriovenous malformation embolization using acrylic and particles: the experiences of a single institution. Neurosurgery 37:606–618, 1995

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 513 162 23
Full Text Views 192 36 2
PDF Downloads 152 29 1
EPUB Downloads 0 0 0