Feasibility and outcomes of endovascular embolization of cerebral arteriovenous malformations at a low-volume centre

Abstract

Background and purpose: Herein, we report our initial experience with the endovascular management
of cerebral arteriovenous malformations (AVMs) using the liquid embolic agent Onyx and n-butyl cyanoacrylate for AVM embolization.
Methods: We reviewed data from 15 patients with brain AVMs, who were observed at our endovascular
facility from January 2008 to July 2011. All cases were embolized with Onyx and/or n-butyl cyanoacrylate.
There were 8 women and 7 men with a mean age of 27.2 years (range 17–43 years). The clinical presentations included intracerebral haemorrhage (n = 7), seizures (n = 4), headache (n = 2), and focal neurological
deficits (n = 2); according to the Spetzler–Martin classification (Spetzler R and Martin N (1986)J Neurosurg V65 446–83), 8 AVMs were grades I–II, 5 were grade III, and 2 were grades IV–V.
Results: A total of 31 embolization procedures were performed in 15 patients, and 44 feeding pedicles
were embolized, ranging from 1 to 5 per patient, with an average size reduction of 70% (median 75%,
range 40–100%). Total obliteration was achieved for 3 AVMs (20%) (2 patients had single feeders and 1
patient had double feeders), and a partial embolization was achieved in 12 patients (80%). The procedure
was related to a permanent disabling morbidity in one patient (6.6%), and no mortalities occurred.
Conclusions: The outcome of (AVM) embolization in our centre is comparable to the reported outcome
in other larger-volume centres. The feasibility and safety of AVM embolization in our low-volume centre
are similar to the outcomes reported at high-volume centre