Endovascular Management of Deep Arteriovenous Malformations: Single Institution Experience in 22 Consecutive Patients.

BACKGROUND

The management of arteriovenous malformations (AVMs) in the basal ganglia, insula, and thalamus is demanding for all treatment modalities.

OBJECTIVE

To define safety and outcomes of embolization used as a stand-alone therapy for deep-seated AVMs.

METHODS

A cohort of 22 patients with AVMs located in the basal ganglia, thalamus, and insula who underwent embolization between January 2008 and December 2013.

RESULTS

Eighteen of 22 (82%) patients had anatomic exclusion. The mean size was 2.98 ± 1.28 cm, and the mean number of sessions was 2.1 per patient. Most patients presented with hemorrhage (82%, n = 18), and 3 (14%) patients were in a deteriorated neurological status (modified Rankin Scale >2) at presentation. Sixty-eight percent of ruptured AVMs had size ≤3 cm. A single transarterial approach was performed in 9 (41%) cases, double catheterization was used in 4 (18%), and the transvenous approach was required in 8 (36%) cases. Procedure-related complications were registered in 3 (14%) cases. One death was associated with treatment, and complementary radiosurgery was required in 2 (9%) patients.

CONCLUSION

Embolization therapy appears to be safe and potentially curative for certain deep AVMs. Our results demonstrate a high percentage of anatomic obliteration with rates of complications that may approach radiosurgery profile. In particular, embolization as stand-alone therapy is most suitable to deep AVMs with small nidus size (≤3 cm) and/or associated with single venous drainage in which microsurgery might not be indicated.