Preoperative embolization of brain AVMs with isobutyl-2 cyanoacrylate

The role of embolization in the management of brain arteriovenous malformations remains controversial. The benefits of embolization alone are not clear and surgical removal may be technically difficult or impossible in many cases. In an attempt to facilitate surgical removal, we performed preoperative embolization in 15 cases using a mixture of isobutyl-2 cyanoacrylate and glacial acetic acid. In one case, a mixture of polyvinyl alcohol particles, microfibrillar collagen, and 30% ethanol was used. In 10 of these cases the surgeon felt that the embolization significantly aided the operative removal by decreasing blood loss, reducing the size of draining veins, and removing portions of the nidus itself. In no patient did the embolization result in an unanticipated significant neurologic deficit. The major role for embolization in the management of brain arteriovenous malformations may be as an aid to surgical removal.