Dominant-hemisphere arteriovenous malformations: therapeutic embolization with isobutyl-2-cyanoacrylate

Embolization treatment of 16 patients with dominant-hemisphere arteriovenous malformations (AVMs) is described. This group was selected from 50 patients with brain AVMs embolized with isobutyl 2-cyanoacrylate (IBC-2) over a period of 3 years. All 16 AVMs were cortical in location; six involved the rolandic and speech areas, and four had a deep component. Ten AVMs were embolized through a transfemoral approach, an intraoperative approach was used for four cases, and a combined transfemoral/intraoperative approach was used in two cases. Complete obliteration of the AVM was obtained in one case. Partial obliteration and complete surgical resection was obtained in three cases. Obliteration of 70%-95% of the AVM was obtained in six cases and 45%-70% of the AVM was obliterated in six cases. IBC-2 embolization of the venous drainage was observed in three cases. After embolization, eight patients remained neurologically unchanged. Three patients had mild neurologic deficits that resolved completely within 48 hr; one had a deficit that cleared up 1 week later; and one had a deficit that disappeared within 6 months. In three patients a mild permanent neurologic deficit was evident 6 months after embolization.