Complications of embolization of arteriovenous malformations of the brain

Abstract

Embolization of AVMs in the brain is associated with low overall rates of mortality and disabling morbidity.

Preoperative Embolization of Cerebral Arteriovenous Malformations with Onyx

“…1,4,[8][9][10][11][12] At that time, the morbidity and mortality rates with preoperative embolization ranged from 3.8% and 1.0% to 28% and 3.7%, respectively. Similar to other investigators, with use of Onyx, our results of a permanent morbidity rate of 12.2% and no deaths after preoperative Onyx embolization are within that range ( 7,17 In the first study, Weber et al examined the morbidity rate in 93 patients treated with Onyx for cAVMs, which apparently was 12% per patient, with no deaths.…”

“…Instead, the treatment intent was to reduce the flow in the cAVM by occlusion of feeding arteries while preserving the draining veins to reduce the risk and increase the success of a subsequent treatment, typically surgery. A median of 2 embolization procedures was performed per patient (range, [1][2][3][4][5] …”

“…1,[4][5][6][8][9][10][11][12] Accordingly, surgery was performed as definitive treatment after preoperative Onyx embolization in more than 50% of the study patients in 5 of 7 centers. 7,[13][14][15][16][17] However, with improving obliteration rates with Onyx and/or n-BCA, radiosurgery is more frequently used as an alternative "definitive" treatment for small residual cAVMs.…”

“…[1][2][3][4][5][6] However, complications secondary to the embolization itself continue to limit its use. Onyx (ev3, Irvine, Calif) is a newer and promising embolic agent, which has become widely available in North America only after its approval by the Food and Drug Administration (FDA) in July 2005.…”

Embolization of Brain Arteriovenous Malformations for Cure: Because We Could or Because We Should?

“…2,3,5,7,8 However, although the overall cure rates in these series have varied, none have demonstrated cure for most of their patients (Table). In addition, the permanent disabling morbidity or mortality rates have been higher than those in several recent large series using predominantly or exclusively n-BCA, [9][10][11][12] which have ranged from 1.6% to 6.5%. Embolization for cure was not the primary aim in most patients treated in these series.…”