Preoperative silk suture embolization of cerebral and dural arteriovenous malformations

Ar, Dehdashti; Muster, Michel; Reverdin, A.; N, de Tribolet; Da, Ruefenacht

doi:10.3171/foc.2001.11.5.7

Cited by 19 publications

(15 citation statements)

References 23 publications

(30 reference statements)

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“…Further, the frequent use of silk sutures in brain and nerve tissue confirms the feasibility of implantation of silk biomaterials in the brain. For example, the relative safety and efficacy of silk sutures for arteriovenous malformation (AVM) and preoperative endovascular embolization has been demonstrated [24,25].…”

Section: Introductionmentioning

confidence: 99%

Silk polymer-based adenosine release: Therapeutic potential for epilepsy

et al. 2008

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Adenosine augmentation therapies (AAT) make rational use of the brain's own adenosine-based seizure control system and hold promise for the therapy of refractory epilepsy. In an effort to develop an AAT compatible with future clinical application, we developed a novel silk protein-based release system for adenosine. Adenosine releasing brain implants with target release doses of 0, 40, 200, and 1,000 ng adenosine/day were prepared by embedding adenosine-containing microspheres into nanofilm-coated silk fibroin scaffolds. In vitro, the respective polymers released 0, 33.4, 170.5, and 819.0 ng adenosine/day over 14 days. The therapeutic potential of the implants was validated in a dose-response study in the rat model of kindling epileptogenesis. Four days prior to the onset of kindling, adenosine-releasing polymers were implanted into the infrahippocampal cleft and progressive acquisition of kindled seizures was monitored over a total of 48 stimulations. We document a dose-dependent retardation of seizure acquisition. In recipients of polymers releasing 819 ng adenosine/day, kindling epileptogenesis was delayed by one week corresponding to 18 kindling stimulations. Histological analysis of brain samples confirmed correct location of implants and electrodes. We conclude that silk-based delivery of around 1,000 ng adenosine/day is a safe and efficient strategy to suppress seizures.

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Section: Introductionmentioning

confidence: 99%

Silk polymer-based adenosine release: Therapeutic potential for epilepsy

et al. 2008

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“…The proportion of patients who presented with AVM rupture was 45%, which is slightly higher than prior silk suture embolization series 9)45). One patient, who had a ruptured AVM, experienced post-embolization hemorrhage (8%).…”

Section: Discussionmentioning

confidence: 59%

“…Histopathological analysis of four patients who underwent silk suture embolization showed an absence or mild amounts of perivascular inflammation and vasculitis 46). In addition to its relatively favorable clinical and histopathological profile, silk suture has a number of definite advantages as an embolic agent 9)47). Silk suture is inexpensive, readily available, easy to manipulate, allows for continuous radiographic monitoring of the microcatheter during and after embolization, and does not interfere with the use of other embolic agents.…”

Section: Discussionmentioning

confidence: 99%

“…Nidal embolization with PVA particles and silk suture can be performed from a proximally located microcatheter, so that the microcatheter does not have to be positioned within the nidus to proceed with silk suture embolization 9). Therefore, less microguidewire and microcatheter navigation are necessary to perform AVM embolization with PVA particles and silk suture, which may reduce the risk of vascular injury to feeding arteries.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Embolization of Cerebral Arteriovenous Malformations with Silk Suture and Particles: Technical Considerations and Outcomes

Conger

Ding

Raper

et al. 2016

J Cerebrovasc Endovasc Neurosurg

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ObjectiveEmbolization of cerebral arteriovenous malformations (AVMs) is commonly performed prior to surgical resection in order to reduce intraoperative bleeding and improve the safety of resection. Although most modern embolization procedures utilize permanent embolic agents, silk suture and polyvinyl alcohol (PVA) particles may offer unique advantages for preoperative devascularization. The aims of this retrospective cohort study are to describe the technical considerations and determine the outcomes for preoperative silk suture and PVA particle embolization (SPE) of AVMs.Materials and MethodsWe performed a retrospective review of our AVM embolization database. AVM patients who underwent preoperative SPE and subsequent surgical resection were included for analysis. Baseline patient demographics, AVM characteristics, embolization and operative records, and post-treatment outcomes were reviewed.ResultsA total of 11 patients who underwent 12 preoperative SPE procedures were included for analysis. Five AVMs were ruptured (45%), and the median nidus volume was 3.0 cm3 (range: 1.3-42.9 cm3). The Spetzler-Martin grade was I-II in seven patients (64%) and III-IV in four patients (36%). The degree of nidal obliteration was less than 25% in two procedures (17%), 25-50% in one procedure (8%), 50-75% in eight procedures (67%), and greater than 75% in one procedure (8%). The rates of post-embolization AVM hemorrhage and mortality were 8% and 0%, respectively. The postoperative angiographic obliteration rate was 100%, and the modified Rankin Scale score improved or stable in 91% of patients (median follow-up duration 2 months).ConclusionPreoperative AVM SPE affords a reasonable risk to benefit profile for appropriately selected patients.

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“…Surgical suture embolization is an accepted method of preoperative reduction of blood flow through brain AVMs [1][2][3][4][5][6][7][8][9] . However, radiolucency is considered to be a major disadvantage of the sutures.…”

Section: Introductionmentioning

confidence: 99%