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Semin intervent Radiol 2003; 20(1): 013-026
DOI: 10.1055/s-2003-38105
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Endovascular Management of Cerebral Arteriovenous Malformations

DeWitte T. Cross, III1 , David T. Jeck2 , Christopher J. Moran2 , Colin P. Derdeyn2
  • 1Associate Professor of Radiology, Washington University School of Medicine, Mallinckrodt Institute of Radiology, Barnes-Jewish & St. Louis Children's Hospitals, St. Louis, Missouri
  • 2Washington University School of Medicine, Mallinckrodt Institute of Radiology, Barnes-Jewish & St. Louis Children's Hospitals, St. Louis, Missouri
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Publication Date:
20 March 2003 (online)

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ABSTRACT

Cerebral arteriovenous malformations (AVMs) may present as incidental findings on imaging studies in completely asymptomatic patients or be the cause of death in others who have suffered massive cerebral hemorrhages. Between those extremes, symptoms may include seizures, focal neurological deficits, headaches, and bruits. Cerebral AVMs may derive their blood supply from pial vessels or dural vessels, or both, and may drain into cortical veins, deep venous sinuses, orbital veins, and spinal veins. The goals of treatment are to eliminate the risk of bleeding and neurological deficits, seizures, and other related symptoms. Methods of treatment include surgical resection of the malformation, stereotaxic radiosurgery, antiseizure medication, embolization, and combinations of the above. Embolization methods include transarterial, transvenous, and direct delivery of embolic agents. Embolic materials include liquid adhesives, polymers, sclerosing agents, particles, coils, and balloons. This article discusses embolization goals, techniques, and complications in the treatment of cerebral AVMs.

KEYWORDS

Cerebral arteriovenous malformations - therapeutic embolization

REFERENCES

  • 1 Luessenhop A J, Spence W T. Artificial embolization of cerebral arteries.  JAMA . 1960;  172 1153
    PubMedGoogle Scholar
  • 2 Wolpert S M, Stein B M. Catheter embolization of intracranial arteriovenous malformations as an aid to surgical excision.  Neuroradiology . 1975;  10 73-85
    PubMedGoogle Scholar
  • 3 Djinjian R. Superselective internal carotid angiography and embolization.  Neuroradiology . 1975;  9 145-156
    CrossrefPubMedGoogle Scholar
  • 4 Kerber C W, Bank W O, Manelfe C. Control and placement of intracranial microcatheters.  Am J Neuroradiol . 1980;  1 157-159
    PubMedGoogle Scholar
  • 5 Debrun G M, Vinuela F V, Fox A J, Kan S. Two different calibrated-leak balloons: experimental work and application in humans.  Am J Neuroradiol . 1982;  3 407-414
    PubMedGoogle Scholar
  • 6 Kikuchi Y, Strother C M, Boyer M. A new catheter for endovascular interventional procedures.  Radiology . 1987;  165 870-871
    PubMedGoogle Scholar
  • 7 Berenstein A. Flow-controlled silicone fluid embolization.  AJR Am J Roentgenol . 1980;  134 1213-1218
    PubMedGoogle Scholar
  • 8 Debrun G, Vinuela F, Fox A, Drake C G. Embolization of cerebral arteriovenous malformations with bucrylate.  J Neurosurg . 1982;  56 615-627
    PubMedGoogle Scholar
  • 9 Merland J J, Rufenacht D, Laurent A, Guimaraens L. Endovascular treatment with isobutyl cyano acrylate in patients with arteriovenous malformations of the brain. Indications, results and complications.  Acta Radiol Suppl . 1986;  369 621-622
    PubMedGoogle Scholar
  • 10 Pelz D M, Fox A J, Vinuela F. Preoperative embolization of brain AVMs with isobutyl-2 cyanoacrylate.  Am J Neuroradiol . 1988;  9 757-764
    PubMedGoogle Scholar
  • 11 Scialfa G, Scotti G. Superselective injection of polyvinyl alcohol microemboli for the treatment of cerebral arteriovenous malformations.  Am J Neuroradiol . 1985;  6 957-960
    PubMedGoogle Scholar
  • 12 Hilal S, Khandji A, Chi L. Synthetic fiber coated platinum coils successfully used for the endovascular treatment of arteriovenous malformations, aneurysms, and direct arteriovenous fistulae of the central nervous system.  Radiology . 1988;  169(Suppl) 28-29
    PubMedGoogle Scholar
  • 13 Arteriovenous malformations of the brain in adults.  N Engl J Med . 1999;  340 1812-1818
    CrossrefPubMedGoogle Scholar
  • 14 Newton T H, Troost B T, Moseley I. Angiography of arteriovenous malformations and fistulas. In: Wilson CB, Stein BM, eds. Intracranial Arteriovenous Malformations Baltimore, MD: Williams & Wilkins 1984: 64-104
    Google Scholar
  • 15 Luessenhop A J. Natural history of cerebral arteriovenous malformations. In: Wilson CB, Stein BM, eds. Intracranial Arteriovenous Malformations Baltimore, MD: Williams & Wilkins 1984: 12-31
    Google Scholar
  • 16 Hurst R W, Hackney D B, Goldberg H I, Davis R A. Reversible arteriovenous malformation-induced venous hypertension as a cause of neurological deficits.  Neurosurgery . 1992;  30 422-425
    PubMedGoogle Scholar
  • 17 Hurst R W, Bagley L J, Galetta S. Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy.  Am J Neuroradiol . 1998;  19 1267-1273
    PubMedGoogle Scholar
  • 18 Lewis A I, Tomsick T A, Tew J M. Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery.  J Neurosurg . 1994;  81 851-859
    CrossrefPubMedGoogle Scholar
  • 19 Ernst R J, Gaskill-Shipley M, Tomsick T A. Cervical myelopathy associated with intracranial dural arteriovenous fistula: MR findings before and after treatment.  Am J Neuroradiol . 1997;  18 1330-1334
    PubMedGoogle Scholar
  • 20 Drake C G. Arteriovenous malformations of the brain. The options for management.  N Engl J Med . 1983;  309 308-310
    PubMedGoogle Scholar
  • 21 Albert P. Personal experience in the treatment of 178 cases of arteriovenous malformations of the brain.  Acta Neurochir (Wien) . 1982;  61 207-226
    CrossrefPubMedGoogle Scholar
  • 22 Spetzler R F, Martin N A. A proposed grading system for arteriovenous malformations.  J Neurosurg . 1986;  65 476-483
    Google Scholar
  • 23 Spetzler R F, Martin N A, Carter L P. Surgical management of large AVMs by staged embolization and operative excision.  J Neurosurg . 1987;  67 17-28
    CrossrefPubMedGoogle Scholar
  • 24 Hamilton M G, Spetzler R F. The prospective application of a grading system for arteriovenous malformations.  Neurosurgery . 1994;  34 2-6
    Google Scholar
  • 25a Leksel L. The stereotaxic method and radiosurgery of the brain.  Acta Chir Scand . 1951;  10 316
    PubMedGoogle Scholar
  • 25b Steiner L. Treatment of arteriovenous malformations by radiosurgery. In: Wilson CB, Stein BM, eds. Intracranial Arteriovenous Malformations Baltimore, MD: Williams & Wilkins 1984: 295-313
    Google Scholar
  • 26 Steiner L, Leksell L, Greitz T. Stereotaxic radiosurgery for cerebral arteriovenous malformations: report of a case.  Acta Chir Scand . 1972;  138 459
    PubMedGoogle Scholar
  • 27 Schlienger M, Atlan D, Lefkopolous D. Linac radiosurgery for cerebral arteriovenous malformations: results in 169 patients.  Int J Radiat Oncol Biol Phys . 2000;  46 1135-1142
    CrossrefPubMedGoogle Scholar
  • 28 Wikholm G, Lundqvist C, Svendsen P. Embolization of cerebral arteriovenous malformations. Part 1: technique, morphology, and complications.  Neurosurgery . 1996;  39 448-457
    PubMedGoogle Scholar
  • 29 Picard L, Miyachi S, Braun M. Arteriovenous malformations of the corpus callosum-radioanatomic study and effectiveness of intranidus embolization.  Neurol Med Chir (Tokyo) . 1996;  36 851-859
    PubMedGoogle Scholar
  • 30 Moran C J, Derdeyn C P, Cross D T, Dacey R G. Magnetic-tipped guidewire-catheter manipulation in patients with intracranial aneurysms.  Radiology . 2001;  221(Suppl) 242
    PubMedGoogle Scholar
  • 31 Piotin M, Ross I B, Weill A. Intracranial arterial aneurysms associated with arteriovenous malformations: endovascular treatment.  Radiology . 2001;  220 506-513
    PubMedGoogle Scholar
  • 32 Meisel H J, Mansmann U, Alvarez H. Cerebral arteriovenous malformations and associated aneurysms: analysis of 305 cases from a series of 662 patients.  Neurosurgery . 2000;  46 793-800
    PubMedGoogle Scholar
  • 33 Dowd C F, Halbach V V, Barnwell S L. Transfemoral venous embolization of vein of Galen malformations.  Am J Neuroradiol . 1990;  11 643-648
    PubMedGoogle Scholar
  • 34 Sorimachi T, Koike T, Takeuchi S. Embolization of cerebral arteriovenous malformations with polyvinyl alcohol particles: angiographic reappearance and complications.  Am J Neuroradiol . 1999;  20 1323-1328
    PubMedGoogle Scholar
  • 35 Mathis J A, Barr J D, Horton J A. The efficacy of particulate embolization combined with stereotactic radiosurgery for treatment of large arteriovenous malformations of the brain.  Am J Neuroradiol . 1995;  16 299-306
    PubMedGoogle Scholar
  • 36 Jahan R, Murayama Y, Gobin Y P. Embolization of arteriovenous malformations with Onyx: clinicopathological experience in 23 patients.  Neurosurgery . 2001;  48 984-995
    CrossrefPubMedGoogle Scholar
  • 37 Yakes W F, Krauth L, Eklund J. Ethanol endovascular management of brain arteriovenous malformations: initial results.  Neurosurgery . 1997;  40 1145-1152
    CrossrefPubMedGoogle Scholar
  • 38 Brothers M F, Kaufmann J C, Fox A J, Deveikis J P. N-butyl 2-cyanoacrylate-substitute for IBCA in interventional neuroradiology: histopathologic and polymerization time studies.  Am J Neuroradiol . 1989;  10 777-786
    PubMedGoogle Scholar
  • 39 Aletich V, Debrun G M, Koenigsberg R. Arteriovenous malformation nidus catheterization with hydrophilic wire and flow-directed catheter.  Am J Neuroradiol . 1997;  18 929-935
    PubMedGoogle Scholar
  • 40 Debrun G M, Aletich V, Ausman J I. Embolization of the nidus of brain arteriovenous malformations with n-butyl cyanoacrylate.  Neurosurgery . 1997;  40 112-120
    PubMedGoogle Scholar
  • 41 Kjellin I B, Boechat M I, Vinuela F. Pulmonary emboli following therapeutic embolization of cerebral erteriovenous malformations in children.  Pediatr Radiol . 2000;  30 279-283
    CrossrefPubMedGoogle Scholar
  • 42 Batjer H H, Devous M D, Meyer Y J. Cerebrovascular hemodynamics in arteriovenous malformation complicated by normal perfusion pressure breakthrough.  Neurosurgery . 1988;  22 503-509
    PubMedGoogle Scholar
  • 43 Tarr R W, Johnson D W, Horton J A. Impaired cerebral vasoreactivity after embolization of arteriovenous malformations: assessment with serial acetazolamide challenge xenon CT.  Am J Neuroradiol . 1991;  12 417-423
    PubMedGoogle Scholar
  • 44 Graf C J, Perret G E, Torner J C. Bleeding from cerebral arteriovenous malformations as part of their natural history.  J Neurosurg . 1983;  58 331
    CrossrefPubMedGoogle Scholar
  • 45 Pile-Spellman J, Young W L, Joshi S. Adenosine-induced cardiac pause for endovascular embolization of cerebral arteriovenous malformations: technical case report.  Neurosurgery . 1999;  44 881-886
    PubMedGoogle Scholar
  • 46 Rauch R A, Vinuela F, Dion J. Preembolization functional evaluation in brain arteriovenous malformations: the ability of superselective Amytal test to predict neurologic dysfunction before embolization.  Am J Neuroradiol . 1992;  13 309-314
    PubMedGoogle Scholar
  • 47 Peters K R, Quisling R G, Gilmore R. Intraarterial use of sodium methohexital for provocative testing during brain embolotherapy.  Am J Neuroradiol . 1993;  14 171-174
    PubMedGoogle Scholar
  • 48 Jafar J J, Davis A J, Berenstein A. The effect of embolization with N-butyl cyanoacrylate prior to surgical removal of cerebral arteriovenous malformations.  J Neurosurg . 1993;  78 60-69
    CrossrefPubMedGoogle Scholar
  • 49 Gobin Y P, Laurent A, Merienne L. Treatment of brain arteriovenous malformations by embolization and radiosurgery.  J Neurosurg . 1996;  85 19-28
    CrossrefPubMedGoogle Scholar
  • 50 Vinuela F, Dion J E, Duckweiler G. Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases.  J Neurosurg . 1991;  75 856-864
    CrossrefPubMedGoogle Scholar
  • 51 Huda W, Peters K R. Radiation-induced temporary epilation after a neuroradiologically guided embolization procedure.  Radiology . 1994;  193 642-644
    PubMedGoogle Scholar
  • 52 Bergeron P, Carrier R, Roy D. Radiation doses to patients in neurointerventional procedures.  Am J Neuroradiol . 1994;  15 1809-1812
    PubMedGoogle Scholar
  • 53 Duffau H, Lopes M, Janosevic V. Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature.  J Neurosurg . 1999;  90 78-84
    CrossrefPubMedGoogle Scholar
  • 54 Kallmes D F, Jensen M E, Cloft H J. Percutaneous transvenous coil embolization of a Djindjian type 4 tentorial dural arteriovenous malformation.  Am J Neuroradiol . 1997;  18 673-676
    PubMedGoogle Scholar
  • 55 Lanzino G, Jensen M E, Kongable G L, Kassell N F. Angiographic characteristics of dural arteriovenous malformations that present with intracranial hemorrhage.  Acta Neurochir (Wien) . 1994;  129 140-145
    CrossrefPubMedGoogle Scholar
  • 56 Cognard C, Gobin Y P, Pierot L. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.  Radiology . 1995;  194 671-680
    CrossrefPubMedGoogle Scholar
  • 57 Dawson R C, Joseph G J, Owens D S, Barrow D L. Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and transverse sinuses.  Am J Neuroradiol . 1998;  19 571-576
    PubMedGoogle Scholar
  • 58 DeMerit J S, Pile-Spellman J, Mast H. Outcome analysis of preoperative embolization with N-butyl cyanoacrylate in cerebral arteriovenous malformations.  Am J Neuroradiol . 1995;  16 1801-1807
    PubMedGoogle Scholar