Deep central arteriovenous malformations of the brain: the role of endovascular treatment

Abstract

Cerebral deep central arteriovenous malformations (AVMs) are uncommon lesions associated with considerable difficulty in treatment. The authors report a series of 14 deep central AVMs treated by endovascular methods and examine the present role of endovascular treatment. This treatment used alone resulted in complete obliteration of AVMs in approximately 15% of case and reduction in 50% to a size permitting treatment by means of radiosurgery. Reversal of previous neurological signs and symptoms occurred in 35.7% of embolized patients. Overall, nearly 80% of patients had either complete obliteration of the lesion, reduction to a size allowing radiosurgical treatment, or reversal of previous neurological deficits. There were treatment complications in 14.3% of the cases. Endovascular treatment methods may make a significant contribution to the therapy of AVMs that have a particularly poor course and are difficult to treat by other means.

Predictors of Total Obliteration in Endovascular Treatment of Cerebral Arteriovenous Malformations

“…These are typically small AVMs, with relatively few arterial pedicles and drainage veins [22][23][24][25][26][27] . The rate of total occlusion in our series is in the reported range.…”

Thalamic Arteriovenous Malformation With an Unusual Draining System-Case Report-

“…9) Other cases of thalamic AVM had drainage exclusively into the supratentorial venous system. 2,4,10) In our case, no bilateral precentral cerebellar veins were identified. We speculate that, for some unknown reason, the precentral cerebellar veins had failed to gain access to the great vein of Galen.…”

“…7) The meningeal artery fed 65% of superficial-and 13% of deep-seated AVMs but none of four nuclear (basal ganglia and thalamus) AVMs. 6) In other studies of thalamic AVM, 2,4,9) none were fed by the meningeal artery.…”

“…2,4,10) Here we report a thalamic AVM partially fed by a meningeal artery, with an unusual draining system flowing only into the infratentorial cerebellar veins.…”

Endovascular Treatment of Deep Hemorrhagic Brain Arteriovenous Malformations with Transvenous Onyx Embolization

“…[5][6][7][8] However, in those cases in which the surgical approach may expose the patient to high risk, such as in deep localizations or eloquent areas, the endovascular and/or radiosurgical treatment may provide better clinical results. 9 Furthermore, the slow effects of radiosurgery may be considered a limitation in hemorrhagic bAVMs because the risk of an early rebleeding would not be reduced. The evolution of endovascular treatment with the introduction of embolizing agents that progressively occlude the lumen of arteries and veins (Onyx 18; ev3-Covidien, Irvine, California) and detachabletip microcatheters has allowed interventional neuroradiologists to plan different strategies to obtain safe curative embolizations of bAVMs.…”