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Embolization of cerebral arteriovenous malformations with silk: histopathologic changes and hemorrhagic complications
F Schmutz1, W McAuliffe, D M Anderson
1Department of Radiology, University of Washington, Seattle 98195, USA.
Purpose:
To evaluate the safety of silk as an embolic agent for preoperative embolization of cerebral arteriovenous malformations (AVMs) by assessing the histopathologic changes and hemorrhagic complications associated with its use.
Methods:
Histopathologic specimens, medical records, and radiologic records of 73 patients with AVMs embolized with silk (alone or in combination with other agents) were reviewed retrospectively. Forty-eight histologic specimens obtained at surgery were analyzed for inflammatory responses and compared with the time interval between embolization and surgery. Postembolization angiograms were assessed for vasculitis and CT scans were reviewed for evidence of hemorrhage after embolization.
Results:
There was no angiographic evidence of vasculitis. Histologic evidence of vasculitis was absent or mild in 92% of cases and histologic evidence of perivascular inflammation was absent or mild in 73% of cases. The frequency of histologic changes associated with vasculitis, perivascular inflammation, and vessel necrosis varied with the time interval between embolization and AVM resection. Intracranial hemorrhage, as a direct complication of silk use, occurred in one patient. Another patient had subarachnoid hemorrhage 24 hours after embolization, caused by rupture of a posteroinferior cerebellar artery aneurysm. Intraventricular high-density material appeared on routine postembolization CT scans in two other patients who had intraventricular AVM extension. This high-density material was thought to be contrast extravasation from intrinsically leaky AVM nidus vessels and not frank hemorrhage.
Conclusion:
Embolization of AVMs with silk does not result in marked inflammation or increased hemorrhagic complications as compared with other agents.
Insights
Silk embolization for cerebral arteriovenous malformations (AVMs) shows minimal inflammation and low hemorrhagic complication rates. This study confirms silk
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Surgery
Background:
- Cerebral arteriovenous malformations (AVMs) are complex vascular lesions requiring treatment.
- Preoperative embolization is a common strategy to reduce AVM size and vascularity.
- The safety profile of embolic agents, including silk, is crucial for patient outcomes.
Purpose of the Study:
- To assess the safety of silk as an embolic agent for cerebral AVM embolization.
- To evaluate histopathologic changes and hemorrhagic complications associated with silk use.
- To compare silk's safety profile against other embolic agents.
Main Methods:
- Retrospective review of 73 patients with AVMs treated with silk embolization.
- Analysis of 48 surgical specimens for inflammatory responses and histopathologic changes.
- Assessment of postembolization angiograms for vasculitis and CT scans for hemorrhage.
Main Results:
- No angiographic evidence of vasculitis was observed.
- Histologic evidence of vasculitis and perivascular inflammation was mild in most cases (92% and 73%, respectively).
- Hemorrhagic complications directly related to silk were infrequent (one case); other events were attributed to aneurysm rupture or AVM characteristics.
Conclusions:
- Silk embolization for cerebral AVMs does not lead to significant inflammation.
- The rate of hemorrhagic complications associated with silk is comparable to other embolic agents.
- Silk is a safe embolic agent for preoperative AVM treatment.