Endovascular transvenous treatment for superficial intracranial arteriovenous malformations

The objective of this study was to evaluate the feasibility and outcomes of transvenous endovascular embolization (TVE) for superficial intracranial arteriovenous malformations (AVMs).

After collecting clinical and imaging data, a prospective series of 11 patients presenting with superficial AVMs were treated by endovascular embolization using a transvenous approach between November 2016 and October 2018.

Ten patients (90.9%) had ruptured AVMs before TVE. The mean nidus size was 3.27 ± 1.47 cm, and the median Spetzler-Martin grade was II. The rate of immediate angiographic occlusion of the AVMs was 90.9% (10/11). One patient was treated with transarterial embolization since TVE was not achieved due to an unsuccessful positioning of the microcatheter. Two patients (cases 8 and 11) suffered a intracranial hemorrhage and a cerebral infarction with encephaledema, respectively, but no procedure-related mortalities were observed. Eight patients (72.7%) were independent with a modified Rankin Score (mRS) ≤ 2 at discharge and the mRSs of all patients, which were collected 30 days postintervention, were not more than 2. The mean follow-up period was 17 months. There were no nidus recurrences during the follow-up period.

The curative transvenous embolization of superficial AVMs seems feasible and effective while carefully monitoring for embolization-related complications.