Complications of preoperative embolization of cerebral arteriovenous malformations

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

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References

  • 1.

    Dowd CFHalbach VVBarnwell SLet al: Particulate embolization of the anterior choroidal artery in the treatment of cerebral arteriovenous malformations. AJNR 12:105510611991Dowd 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 MBDutton KPurdy PD: Assessment of complication types and rates related to diagnostic angiography and interventional neuroradiologic procedures: a four year review (1993–1996). Intervent Neuroradiol 4:27371998Horowitz 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 RMurayama YGobin YPet al: Embolization of arteriovenous malformations with Onyx: clinicopathological experience in 23 patients. Neurosurgery 48:9849972001Jahan 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 HMHuang YCWang YH: Embolization of cerebral arteriovenous malformations with n-butyl-2—cyanoacrylate. J Formos Med Assoc 99:9069132000Liu 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 HJMansmann UAlvarez Het al: Effect of partial targeted N-butyl-cyano-acrylate embolization in brain AVM. Acta Neurochir 144:8798882002Meisel 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 PHNornes H: Superselective angiography, embolization and surgery in treatment of arteriovenous malformations of the brain. Neuroradiology 36:4104131994Nakstad 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 23:7487552002The 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 JKEskridge JMChung ECet al: Preoperative embolization of cerebral arteriovenous malformations with silk sutures: analysis and clinical correlation of complications revealed on computerized tomography scanning. J Neurosurg 92:9559602000Song 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 TKoike TTakeuchi Set al: Embolization of cerebral arteriovenous malformations achieved with polyvinyl alcohol particles: angiographic reappearance and complications. AJNR 20:132313281999Sorimachi 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 RCFlom RAKhayata MHet al: The safety and effectiveness of brain arteriovenous malformation embolization using acrylic and particles: the experiences of a single institution. Neurosurgery 37:6066181995Wallace 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

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