Angiographic factors influencing the success of endovascular treatment of arteriovenous malformations involving the corpus callosum

Abstract

AVMs of the corpus callosum seems to be difficult to treat with endovascular therapy alone. The goal of embolization should be prevention of (re) bleeding and a decrease in nidus size. Our experience regarding this sub-pathology suggests that a combination of endovascular therapy and radiotherapy may be the best option.

Arteriovenous malformations of the corpus callosum: Pooled analysis and systematic review of literature

“…The complication rate associated with these procedures ranges from 5% to 20%. [ 37 39 49 ] Our analysis of the literature revealed that fifty patients underwent standalone endovascular embolization of the AVM and cure was achieved in only 20 (40%), similar to the results noted by Picard et al . Only four patients underwent presurgical embolization of their AVMs, of which 3 (75%) were completely excised.…”

“…No prospective cohorts or randomized studies were found. [ 2 3 4 5 6 8 10 11 12 15 16 17 18 19 20 21 23 24 25 26 27 28 29 30 31 32 33 34 37 38 39 40 41 42 47 48 50 53 54 ]…”

“…A more recent study showed that more than half of the CC-AVMs in the series were completely obliterated using endovascular therapy alone, largely due to recent advances in the field and the advent of more sophisticated catheters and embolization material. [ 37 39 49 ] The same study also assessed the factors responsible for incomplete obliteration and found that holocallosal type, extension of the nidus to an eloquent area, nidus size >30 mm, and a Spetzler-Martin grade ≥3 were associated with failed endovascular treatment. The complication rate associated with these procedures ranges from 5% to 20%.…”

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

“…The number and diameter of feeding arteries, nidal volume, deep venous drainage, and eloquent location were risk factors of embolization-related complications ( 47 , 54 , 55 ). When disposing of bAVMs in corpus callosum with complex angioarchitectures and eloquence involved, curative embolization achieved complete obliteration in only 40–60% of cases and hemorrhage complications occurred in 7% of cases ( 197 , 198 ).…”

Microsurgical Resection of a Callosal Septal Arteriovenous Malformation: 2-Dimensional Operative Video

“…1 Resection of callosal AVMs presents unique challenges because of their deep location; proximity to critical structures, such as the fornices and internal cerebral veins; and often-dense beds of arterial feeders arising from the distal anterior cerebral artery and its branches. [1][2][3][4] This operative video shows complete resection of a complex, high-grade AVM involving the entire corpus callosum of a teenage woman who presented with headache and decreased level of consciousness. Head computed tomography findings included intraventricular hemorrhage; follow-up computed tomography and digital subtraction angiography confirmed a pancallosal AVM, classified as Spetzler-Martin grade IV (size, 2; deep drainage, 1; eloquence, 1) and Lawton-Young grade I (age, 1; bleeding, 0; compactness, 0), with a supplemented grade of 5.…”