Endovascular treatment of intracranial microarteriovenous malformations

Clinical article

Restricted access

Object

Microarteriovenous malformations (micro-AVMs) are an uncommon subgroup of brain AVMs defined by a nidus measuring < 1 cm in diameter. The clinical features, angiographic characteristics, and outcomes in patients with micro-AVMs who had been treated endovascularly after presenting with hemorrhage were reviewed to identify common features affecting prognosis.

Methods

Between 1997 and 2006, 25 patients (12 females and 13 males) with 26 micro-AVMs were treated. Twenty-four patients presented with intracerebral hematoma and 1 with subarachnoid hemorrhage only. All patients underwent CT on admission, diagnostic cerebral angiography, and 1 session of endovascular treatment during the acute phase.

Results

Procedure-related complications occurred in 3 patients (12%), which caused temporary hemiparesis in 1 (4%) and no clinical sequelae in 2 patients (8%). Complete nidus obliteration was achieved at the end of the embolization in 22 (84.6%) of 26 lesions. Two recurrences were evident on follow-up angiography 6 months postembolization, resulting in a complete obliteration rate of 77% (20 of 26 lesions) after a single treatment. Late angiography was performed in 12 patients, and no further recurrences were identified.

Conclusions

Immediate complete obliteration of a micro-AVM with a high permanent cure and low morbidity rates was accomplished using endovascular treatment. Early embolization after bleeding should be considered as an alternative to resection.

Abbreviations used in this paper:AICA = anterior inferior cerebellar artery; AVM = arteriovenous malformation; DS = digital subtraction; GCS = Glasgow Coma Scale; ICH = intracerebral hematoma; NBCA = N-butyl-cyanoacrylate; SAH = subarachnoid hemorrhage; SCA = superior cerebellar artery.
Article Information

Contributor Notes

Address correspondence to: Ioannis Ioannidis, M.D., Ph.D., Diagnostic & Therapeutic Center of Athens Hygeia SA, Erythrou Stavrou 4, Marousi, Athens, Greece 15234. email: iioann@hotmail.com.
Headings
References
  • 1

    Berenstein ALasjaunias PterBrugge KG: Surgical Neuroangiography New YorkSpringer-Verlag2004. 655656

  • 2

    Cellerini MMangiafico SVilla GNistri MPandolfo CNoubari H: Cerebral microarteriovenous malformations: diagnostic and therapeutic features in a series of patients. AJNR Am J Neuroradiol 23:9459522002

    • Search Google Scholar
    • Export Citation
  • 3

    Deruty RPelissou-Guyotat IMottolese CSoustiel JF: Ruptured occult arteriovenous malformation associated with an unruptured intracranial aneurysm: report of three cases. Neurosurgery 30:6036071992

    • Search Google Scholar
    • Export Citation
  • 4

    Hino AFujimoto MYamaki TIwamoto YKatsumori T: Value of repeat angiography in patients with spontaneous subcortical hemorrhage. Stroke 29:251725211998

    • Search Google Scholar
    • Export Citation
  • 5

    Jensen HPBrumlik JBoshes B: The application of serial angiography to diagnosis of the smallest cerebral angiomatous malformations. J Nerv Ment Dis 136:1141963

    • Search Google Scholar
    • Export Citation
  • 6

    Margolis GOdom GLWoodhall BBloor BM: The role of small angiomatous malformations in the production of intracerebral hematomas. J Neurosurg 8:5645751951

    • Search Google Scholar
    • Export Citation
  • 7

    Nataf FMerienne LSchlienger MLefkopoulos DMeder JFTouboul E: Cerebral arteriovenous malformations treated by radiosurgery: a series of 705 cases. Neurochirurgie 47:2682822001

    • Search Google Scholar
    • Export Citation
  • 8

    Perrini PScollato ACellerini MMangiafico SAmmannati FMennonna P: Results of surgical and endovascular treatment of intracranial micro-arteriovenous malformations with emphasis on superselective angiography. Acta Neurochir (Wien) 146:7557662004

    • Search Google Scholar
    • Export Citation
  • 9

    Schaller CSchramm J: Microsurgical results for small arteriovenous malformations accessible for radiosurgical or embolization treatment. Neurosurgery 40:6646741997

    • Search Google Scholar
    • Export Citation
  • 10

    Spetzler RFHargraves RWMcCormick PWZabramski JMFlom RAZimmerman RS: Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations. J Neurosurg 76:9189231992

    • Search Google Scholar
    • Export Citation
  • 11

    Stefani MAPorter PJTerBrugge KGMontanera WWillinsky RAWallace MC: Angioarchitectural factors present in brain arteriovenous malformations associated with hemorrhagic presentation. Stroke 33:9209242002

    • Search Google Scholar
    • Export Citation
  • 12

    Stiver SIOgilvy CS: Micro-arteriovenous malformations: significant hemorrhage from small arteriovenous shunts. Neurosurgery 46:8118192000

    • Search Google Scholar
    • Export Citation
  • 13

    Tanaka MValavanis A: Role of superselective angiography in the detection and endovascular treatment of ruptured occult arteriovenous malformations. Interventional Neuroradiology 7:3033312001

    • Search Google Scholar
    • Export Citation
  • 14

    Teasdale GJennet B: Assessment of coma and impaired consciousness: a practical scale. Lancet 2:81841974

  • 15

    UK-TIA Study Group: The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: interim results. Br Med J (Clin Res Ed) 296:3163201988

    • Search Google Scholar
    • Export Citation
  • 16

    van Rooij WJSluzewski MBeute GN: Brain AVM embolization with Onyx. AJNR Am J Neuroradiol 28:1721782007

  • 17

    Willinsky RLasjaunias PComoy JPruvost P: Cerebral microarteriovenous malformations (mAVMs). Review of 13 cases. Acta Neurochir (Wien) 91:37411988

    • Search Google Scholar
    • Export Citation
  • 18

    Willinsky RTerBruge KMontanera WWallace CAggarwal S: Micro-arteriovenous malformations of the brain: superselective angiography in diagnosis and treatment. AJNR Am J Neuroradiol 13:3253301992

    • Search Google Scholar
    • Export Citation
  • 19

    Yaºargil MG: Microneurosurgery: AVM of the Brain History Embryology Pathological Considerations Hemodynamics Diagnostic Studies Microsurgical Anatomy StuttgartGeorg Thieme1987. Vol IIIA:85

    • Search Google Scholar
    • Export Citation
  • 20

    Yu SCChan MSLam JMTam PHPoon WS: Complete obliteration of intracranial arteriovenous malformation with endovascular cyanoacrylate embolization. Initial success and rate of permanent cure. AJNR Am J Neuroradiol 25:1139 11432004

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 104 88 7
Full Text Views 99 28 0
PDF Downloads 89 29 0
EPUB Downloads 0 0 0
PubMed
Google Scholar