Transarterial Embolization of Brain Arteriovenous Malformations

Sultan, Ahmed; Hassan, Tamer; El-Saadany, Waleed F.; Nagy, Erzsébet

doi:10.1097/wnq.0b013e31828c70ad

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Recent studies have reported that standalone endovascular embolization was associated with complete cure in more than 50% of cases, while old ones reported only 5-20% cure with embolization. [20][21][22] This was mostly due to embolization being used previously as an adjuvant treatment and not for curable aims. Also, initial embolic agents like polyvinyl alcohol particles and old microcatheters were not helpful to fill the AVM nidus in a safe and a permanent way, thus recanalization was very high.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Sultan

Abouzeid²,

Shadad³

2022

Pan Arab Journal of Neurosurgery

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BACKGROUND:Although pediatric arteriovenous malformations (AVMs) are relatively rare, they carry a higher rate of rupture than in adults. Pediatric AVMs could also present with recurrent seizures or headaches. Endovascular embolization is usually achievable in pediatric AVMs with increasing complete obliteration rates, especially in cases with small AVMs. It also serves as adjuvant therapy with microsurgery or radiosurgery in larger AVMs. Long-term follow-up is required to confirm the efficiency of endovascular AVM obliteration, especially in young populations with the longest life expectancy. OBJECTIVE:The aim of the study was to perform a multicenter analysis of embolized pediatric cerebral AVMs regarding the clinical and radiological outcomes with a long term follow up. METHODS:A retrospective study of 57 pediatric patients diagnosed with cerebral AVMs and admitted to departments of neurosurgery at Alexandria, Sohag and Tanta University hospitals was conducted. All patients were subjected to clinical and radiological assessments. Endovascular embolization was done for all cases in one or two sessions. Complementary treatment included microsurgery and radiosurgery. Clinical and radiological follow-ups were done for all patients for at least one year. The outcome measures were angiographic disappearance of the AVM nidus and neurological improvement on clinical followup. RESULTS:The study included 57 pediatric patients with age range between 4-18 years. Fifty-four patients (94.73%) presented with intracranial hemorrhage and 3 patients (5.26%) presented with seizures. All patients were treated with endovascular embolization as a primary modality of treatment. Total obliteration of the AVM was achieved in one session in 30 patients (52.63%) and in 2 sessions in 8 patients (14.03%). After endovascular embolization, 7 patients (12.28%) underwent microsurgical excision, and another 12 patients (21.05%) were referred to radiosurgery. All patients had no permanent morbidity or mortality related to the embolization technique. Five patients (8.77%) had transient neurological deficits. One patient had minimal subarachnoid hemorrhage (SAH) due to microwire perforation and another patient had temporary pulmonary edema due to the effect of dimethyl sulfoxide on lung; both patients improved with medical treatment. One patient had a retained tip of a microcatheter which was removed with surgery.CONCLUSION: Endovascular embolization is a safe and effective technique as a single modality in the management of pediatric AVMs. It has extended the role of microsurgery and radiosurgery to treat previously non-curable high-grade lesions. Long-term follow-up over 3 years confirms stable occlusion. A longer follow-up is still needed due to the long life expectancy.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Sultan

Abouzeid²,

Shadad³

2022

Pan Arab Journal of Neurosurgery

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“…Similar complications of Onyx could happen when injecting it in ECA feeders supplying brain arteriovenous malformation or cranial dural arteriovenous fistula as previously reported in the literature. [57][58][59][60][61] …”

Section: Onyx Embolic Materialsmentioning

confidence: 98%

Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience

Hassan

Rashad

Aziz

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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“…Many authors had observed the effectiveness of Onyx for obliteration of brain hemangioblastoma. 2,10–14 n -Butyl cyanoacrylate (NBCA), after replacing the previously known particulate embolic agents before Onyx introduction, has provided relatively good results in vascular brain lesions. NBCA requires multiple super-selective catheterizations on the reverse of Onyx to obliterate the lesion.…”

Section: Concept Changementioning

confidence: 99%

“…The rapid polymerization and adhesive characteristics limit the injection time and penetration. 10,15 We used NBCA in one case of our series with near total obliteration. We used PVA at the start of our series because Onyx was not available in Egypt at that time; NBCA was used in only one case.…”

Section: Concept Changementioning

confidence: 99%

“…[1][2][3]8,9 The concept of surgery now changes to piecemeal removal rather that one of mass extraction after 360 devascularization, embolic agents available include coils, particles, and liquid agents. 10 The choice of the optimal embolic agent depends on hemodynamic factors and vascular anatomy. Coils can be used to dampen the blood flow of high flow fistulas before usage of other materials.…”

Section: Concept Changementioning

confidence: 99%

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The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas

et al. 2016

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Background Solid cerebellar hemangioblastomas are highly vascular lesions and may cause catastrophic hemorrhage during excision. Methods This retrospective study enrolled 10 patients (7 men and 3 women, with a mean age of 38.2 ± 12.5 years) with solid cerebellar hemangioblastomas. All patients had a solitary tumor and underwent surgical resection of the lesion through a suboccipital approach. The basic features, serial radiographic examinations, and operative records were analyzed. Results The most common presenting symptoms were headache (100%), ataxia (100%), and long tract manifestations (60%). Three patients had experienced failed surgery previously due to massive intraoperative bleeding. Three patients were confirmed as having Von Hippel–Lindau disease. The average size of the tumor was 40.7 ± 8.7 mm in its maximal diameter (range 25–58 mm). Total endovascular occlusion obtained in six patients, near total occlusion in three patients, and incomplete occlusion in one patient. Nine (90.0%) patients underwent gross total resection and one (10.0%) underwent partial resection. After the primary surgery, eight (80.0%) patients experienced improvement in their symptoms, two (20.0%) maintained their pre-treatment status, and none showed neurological deterioration following tumor resection. Blood loss during surgery after embolization was minimal and controllable. Conclusion Preoperative embolization improves safety and efficacy of the microsurgical excision of such tightly located very vascular tumors. Embolization changes the concept of this lesion surgery into piecemeal removal rather than a total mass extraction technique. Liquid agents are superior to particles in obliteration of such lesions.

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Transarterial Embolization of Brain Arteriovenous Malformations

Cited by 5 publications

References 12 publications

Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience

The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas

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