scholarly journals Preoperative Embolization of Cerebral Arteriovenous Malformations with Onyx

2008 ◽  
Vol 30 (3) ◽  
pp. 492-495 ◽  
Author(s):  
E.F. Hauck ◽  
B.G. Welch ◽  
J.A. White ◽  
P.D. Purdy ◽  
L.G. Pride ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Cerebral Arteriovenous Malformations

Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations

2017 ◽  
Vol 104 ◽  
pp. 430-441 ◽  
Author(s):  
Andrew S. Luksik ◽  
Jody Law ◽  
Wuyang Yang ◽  
Tomas Garzon-Muvdi ◽  
Justin M. Caplan ◽  
...  
Keyword(s):  
Surgical Management ◽  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Cerebral Arteriovenous Malformations

Hemodynamic Effects of Preoperative Embolization in Cerebral Arteriovenous Malformations

Neurosurgery ◽  
1992 ◽  
Vol 31 (5) ◽  
pp. 877???885 ◽  
Author(s):  
Franco Chioffi ◽  
Alberto Pasqualin ◽  
Alberto Beltramello ◽  
Renato Da Pian
Keyword(s):  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Hemodynamic Effects ◽  
Cerebral Arteriovenous Malformations

Treatment of Cerebral Arteriovenous Malformations with a Combination of Preoperative Embolization and Surgery

Neurosurgery ◽  
1991 ◽  
Vol 29 (3) ◽  
pp. 358-368 ◽  
Author(s):  
Alberto Pasqualin ◽  
Renato Scienza ◽  
Fabrizia Cioffi ◽  
Giovanni Barone ◽  
Aldo Benati ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Malformations ◽  
Combined Treatment ◽  
Neurological Deficits ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Selective Embolization ◽  
Intraoperative Bleeding ◽  
Microsurgical Approach

Abstract Forty-nine patients with cerebral arteriovenous malformations (AVMs) were treated with preoperative embolization followed by resection using a microsurgical approach. In 27 patients, the AVM was located in an eloquent area; in 32 patients, the volume of the AVM was over 20 cm3. Preoperatively, flow-directed embolization was performed in 10 patients (28 procedures), selective embolization with threads was performed in 35 patients (46 procedures), and a combination of flow-directed and selective embolization was performed in 4 patients (12 procedures). The percentage of reduction of the AVM volume averaged 36% after embolization. Five minor complications (transient neurological deficits, in 2 cases associated with ischemic areas on the CT scan) were observed after embolization. The interval between the last embolization and surgery was as follows: within 10 days in 7 patients; between 11 and 20 days in 3 patients; between 21 and 30 days in 10 patients; between 31 and 60 days in 11 patients; and 2 months later in 18 patients. The efficacy of this combined treatment (embolization plus surgery) was evaluated by the incidence of hyperemic complications and the clinical outcome. Hyperemic complications occurred more frequently in patients with an AVM volume greater than 20 cm3. When compared with flow-directed embolization, selective embolization was linked with decreased bleeding during surgery; postoperatively, the incidence of cerebral edema was also lower. Clinical outcome was better after selective embolization, with no occurrence of major deficits and no mortality. When the percentage of reduction of the AVM volume after embolization was 40% or more, the incidence of intraoperative hyperemic complications was lower; moreover, new permanent deficits were never observed in patients with this volume reduction. A retrospective clinical comparison of two groups of patients with similar AVM volumes (>20 cm3)—those given combined treatment (n = 32) versus those treated by direct surgery alone (n = 27)—showed that intraoperative bleeding appeared to decrease in patients treated by embolization; the incidence of postoperative hyperemic complications was not different in the two groups. New major deficits and deaths were less frequent in patients treated by embolization (P= 0.05 for the incidence of major deficits); postoperative epilepsy was also less common in these patients. In conclusion, combined treatment with selective preoperative embolization and direct surgery may help the neurosurgeon in the treatment of large, high-flow AVMs, reducing the risks connected with their surgical removal. (Neurosurgery 29:358-368, 1991)

The effect of embolization with N-butyl cyanoacrylate prior to surgical resection of cerebral arteriovenous malformations

1993 ◽  
Vol 78 (1) ◽  
pp. 60-69 ◽  
Author(s):  
Jafar J. Jafar ◽  
Adam J. Davis ◽  
Alejandro Berenstein ◽  
In Sup Choi ◽  
Mark J. Kupersmith
Keyword(s):  
Blood Loss ◽  
Surgical Resection ◽  
Surgical Complications ◽  
Neurological Outcome ◽  
Arteriovenous Malformations ◽  
Operative Time ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Cerebral Arteriovenous Malformations ◽  
Significant Difference

✓ Endovascular therapy of cerebral arteriovenous malformations (AVM's) is an accepted adjunct to surgical therapy. However, the literature has not characterized the benefits or the liabilities of preoperative embolization. This series compares two groups of patients who underwent surgical resection of a cerebral AVM; one group (20 patients) received preoperative transfemoral selective embolization with N-butyl cyanoacrylate (NBCA) and the other group (13 patients) did not. In the group with preoperative embolization, the AVM's were larger (3.9 vs. 2.3 cm) and of a higher Spetzler-Martin grade (3.2 vs. 2.5) as compared to the nonembolized group. The NBCA embolization facilitated surgical resection. Arteries supplying the vascular malformation were readily distinguished from those supplying the normal brain parenchyma. Embolized vessels were compressible and easily cut with microscissors. No bleeding occurred from transected vessels. Operative time and intraoperative blood loss for the two groups were not statistically different, despite the significant differences in lesion size and grade. Endovascular complications included immediate and delayed hemorrhage (15%) and transient ischemia (5%); there were no embolization-related deaths. Postoperative complications for both groups included hemorrhage (15%), residual AVM (6%), and cerebrospinal fluid leak (3%); the mortality rate was 3%. There was no statistically significant difference in surgical complications between the embolized and nonembolized groups. Most patients (91%) in both groups had an excellent or good late neurological outcome, with no significant difference between the groups. This study concludes that preoperative NBCA embolization of AVM's makes lesions of larger size and higher grade the surgical equivalent of lesions of smaller size and lower grade by reducing operative time and intraoperative blood loss, with no statistically significant difference in surgical complications or long-term neurological outcome.

Preoperative embolization of cerebral arteriovenous malformations with silk sutures: analysis and clinical correlation of complications revealed on computerized tomography scanning

2000 ◽  
Vol 92 (6) ◽  
pp. 955-960 ◽  
Author(s):  
Joon K. Song ◽  
Joseph M. Eskridge ◽  
Eun-Chul Chung ◽  
Lindsey C. Blake ◽  
J. Paul Elliott ◽  
...  
Keyword(s):  
Computerized Tomography ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Ct Scans ◽  
Preoperative Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Arteriovenous Shunting ◽  
Content Type ◽  
Ct Findings ◽  
Fine Print

Object. The aim of this study was to determine the incidence and clinical significance of complications related to preoperative embolization of cerebral arteriovenous malformations (AVMs) with silk sutures as documented on postprocedure computerized tomography (CT) scans.Methods. The CT scans were obtained within 12 to 24 hours after 221 (96%) of 230 consecutive embolizations in 70 patients. These CT scans were evaluated for the presence of ischemia, infarction, hemorrhage, or contrast agent extravasation. Adverse patient outcomes were determined after each embolization and were correlated with CT findings. New abnormalities demonstrated on CT scans were also correlated with the Spetzler—Martin AVM grade, degree of arteriovenous shunting, and location. New abnormalities, the majority of them infarcts, resulted from 29 (13%) of 221 embolization procedures. In 11 (38%) of 29 cases of new CT findings, patients were asymptomatic, including 10 with new infarcts on CT scans. New neurological deficits occurred in 20 (8.7%) of 230 total embolization procedures in 19 patients, including one death. Permanent deficits occurred in nine patients (3.9% per embolization procedure, 12.8% per patient). Of the patients with new neurological deficits, 18 (90%) of 20 embolization procedures resulted in new abnormalities on CT scans. Two patients with new transient neurological deficits had no new findings on CT scans. Spetzler—Martin grade, AVM location, degree of arteriovenous shunting, and higher numbers of procedures were not statistically associated with a higher incidence of abnormalities on CT scans or new permanent neurological deficits.Conclusions. Silk sutures are an effective and relatively safe embolic agent. After brain AVM embolization with silk sutures, new abnormalities were found on CT scans obtained in one of eight procedures. When a new CT finding occurred, the patient had roughly equal chances of having no new symptoms, having new transient neurological deficits, or having new permanent neurological deficits.

Complications of preoperative embolization of cerebral arteriovenous malformations

2004 ◽  
Vol 100 (5) ◽  
pp. 810-812 ◽  
Author(s):  
Christopher L. Taylor ◽  
Kim Dutton ◽  
George Rappard ◽  
G. Lee Pride ◽  
Robert Replogle ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Liquid Polymer ◽  
Poor Outcome ◽  
Detachable Coils ◽  
Permanent Neurological Deficit ◽  
Fine Print

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.

Hemodynamic Effects of Preoperative Embolization in Cerebral Arteriovenous Malformations

Neurosurgery ◽  
1992 ◽  
Vol 31 (5) ◽  
pp. 877-885 ◽  
Author(s):  
Franco Chioffi ◽  
Alberto Pasqualin ◽  
Alberto Beltramello ◽  
Renato Da Pian
Keyword(s):  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Hemodynamic Effects ◽  
Cerebral Arteriovenous Malformations
Sign in / Sign up

Export Citation Format

Share Document