Embolization of the AVM proper is considered to be more efficacious than the proximal occlusion of arterial feeders.8,9,14,19,24,26 Materials that consistently and reliably penetrate the AVM are limited to acrylic agents and polyvinyl alcohol mixtures. Acrylic agents may be more advantageous since they permanently occlude the vessel and do not recanalize when a solid column is introduced. Isobutyl 2-cyanoacrylate (IBCA) has been the predominant acrylic used in endovascular therapy of AVM's; however, IBCA has been criticized for complicating the surgical resection of vascular malformations.15,17,21 A more accommodating embolization material is required to assist the surgeon intraoperatively. Since 1987, the authors have used N-butyl cyanoacrylate* (NBCA) exclusively for the endovascular treatment of AVM's. It was thought that, because of advantageous material properties, NBCA would be superior to IBCA for this treatment.
Studies suggest that preoperative embolization of AVM's decreases the operative time and the amount of blood loss; however, statistical analysis with comparable data from nonembolized patients is lacking.5–7,19 The only study16 demonstrating a statistically significant reduction in intraoperative bleeding as well as improved postoperative clinical outcome following the use of preoperative embolization utilized selective embolization with polyfilament polylene threads. Statistical evidence supporting the benefit of acrylic embolization is not available in the literature.
This study evaluates the effect of preoperative embolization with NBCA on the surgical resection of AVM's. Two concurrent groups of patients underwent surgical resection of purely parenchymal cerebral AVM's. One group received preoperative transfemoral selective embolization with NBCA. The impact of embolization upon the technical aspects of AVM resection, the operative time and blood loss, and the complications and clinical outcome are examined.
The authors wish to thank Dr. Henry Cohen, Department of Environmental Medicine, New York University, for rigorous and critical review of the statistical analysis contained within this paper.
Drake CG: Cerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases. Clin Neurosurg 26:145–2081979Drake CG: Cerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases. Clin Neurosurg 26:
Viñuela FVDion JEFox AJet al: Interventional neuroradiology for intracranial arteriovenous malformationsBarrow DL (ed): Intracranial Vascular Malformations. Park Ridge, Ill: American Association of Neurological Surgeons1990169–178Intracranial Vascular Malformations.
Avacryl manufactured by Tripoint Medical Industries, Inc., Raleigh, North Carolina.