Embolization of cerebral arteriovenous malformations with bucrylate

Forty-six patients with cerebral arteriovenous malformations (AVM's) were selected for embolization with bucrylate. These patients were assigned to three different groups. Group I consisted of 22 patients with nonresectable AVM's who were selected for embolization with a Silastic calibrated-leak ballon. In 16 or these patients, embolization was achieved, with partial obliteration of the AVM in 14 and complete obliteration in two. Five patients had subarachnoid hemorrhage caused by the balloon bursting and concomitant dissection of the feeding vessel. Four of these patients recovered completely and one died of a brain-stem hemorrhage. A permanent field defect was noted in five cases, and two patients had a transient mild neurological deficit. Group II consisted of 13 patients treated by intraoperative embolization. Complete obliteration by embolization was obtained in four cases, and complete surgical resection after embolization in five. Partial embolization with no surgical resection was achieved in five cases. Three of these patients had a permanent mild neurological deficit and two had transient deficits. There was no mortality in this group. Group III consisted of 11 patients treated by embolization with bucrylate using a new latex calibrated-leak balloon. This balloon has a higher malleability, and takes on the exact configuration of the feeder, with no risk of dissection. This balloon also permits delivery of the faster and larger injection of bucrylate to the arterial feeders of the AVM. Two AVM's were completely obliterated, and embolization was only partially successful in the other cases. Neurological complications consisted of incomplete field defects in two cases, slight memory loss in one case, and transient clumsiness of the arm and face in one case. Two patients have a catheter permanently glued in the malformation, with no neurological complication. There was no mortality in this group.