Extending the indications for transvenous approach embolization for superficial brain arteriovenous malformations

• Published in: Journal of neurointerventional surgery Vol. 9; no. 11; p. 1053
• Main Authors: Viana, Dinark Conceição, de Castro-Afonso, Luis Henrique, Nakiri, Guilherme Seizem, Monsignore, Lucas Moretti, Trivelato, Felipe Padovani, Colli, Benedicto Oscar, Abud, Daniel Giansante
• Format: Journal Article
• Language: English
• Published: England 01-11-2017
• Subjects: Adolescent; Adult; Aged; Angiography - methods; Arteriovenous Fistula - diagnostic imaging; Arteriovenous Fistula - therapy; Cerebral Veins - diagnostic imaging; Child; Embolization, Therapeutic - methods; Female; Follow-Up Studies; Humans; Intracranial Arteriovenous Malformations - diagnostic imaging; Intracranial Arteriovenous Malformations - therapy; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Young Adult; Intracranial arteriovenous malformations; Onyx; Transvenous embolization
• ISSN: 1759-8486
• DOI: 10.1136/neurintsurg-2017-013113

Transarterial embolization is the standard endovascular treatment strategy for intracranial arteriovenous malformations (AVMs). The transvenous approach has been indicated for the embolization of deep AVMs meeting a set of strict eligibility criteria. The present study aims to assess the safety and efficacy of the transvenous approach for superficial AVMs.
A retrospective series of 12 patients presenting with cortical AVMs were treated by endovascular embolization using a transvenous approach with a curative intent.
Nine patients (75%) had ruptured AVMs at admission. The mean nidus size was 1.9 cm, six patients (50%) had a nidus in eloquent areas and the median Spetzler-Martin grade was 2. The rate of immediate angiographic occlusion of the AVMs was 91.6% (11/12). One patient in whom immediate angiographic occlusion was not achieved showed spontaneous occlusion at the 6-month follow-up. No procedural or clinical complications were observed. The mean and median modified Rankin scale (mRS) scores at discharge were 1.7 and 2 (range 0-3, SD=0.96), and the mean and median mRS scores at 6 months were 1.6 and 2 (0-3, 1.16). Nine patients (75%) were independent (mRS ≤2) at discharge and 11 patients (91.6%) were independent (mRS ≤2) at the 6-month follow-up.
The curative transvenous embolization of superficial intracranial AVMs is feasible and appears safe and effective when strict anatomical selection is respected. This technique extends the current indications for transvenous embolization of intracranial AVMs and may improve cure rates while reducing embolization-related complications.