Arteriovenous malformations of the brain: recent results of endovascular therapy

Results of embolization and subsequent surgical resection were reviewed in 38 patients with arteriovenous malformations (AVMs) of the brain during the past 3 years. Advanced techniques were used for embolization, including real-time digital subtraction angiofluoroscopy; directable microcatheters; and a mixture of microfibrillar collagen, polyvinyl alcohol sponge microparticles, and ethanol, in addition to acrylic glue. Embolization caused a permanent deficit in four patients (10.5%) (quadrantanopia [n = 3], cerebellar ataxia [n = 1]). Thirty-two patients (84%) underwent surgery after embolization, and 28 (74%) were completely cured, as assessed with postsurgical angiography. Twenty-five patients (66%) had either no deficit or no change in deficit after treatment. Two patients had worsening of a previous deficit after postembolization resection, two patients had mild weakness not previously present, and five patients had visual field defects. One patient developed Gerstmann syndrome after resection, and one patient with ataxia after embolization also had ataxia after surgical resection. Two patients died of complications due to surgical resection. Most of the AVMs in this series were large and complex. Embolization used predominantly as a preoperative procedure enabled complete resection, as achieved in the majority of these cases.