1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
2Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; and.
Neurosurg Focus. 2018 Jul;45(1):E13. doi: 10.3171/2018.3.FOCUS18113.
Endovascular embolization of brain arteriovenous malformations (AVMs) is conventionally performed from a transarterial approach. Transarterial AVM embolization can be a standalone treatment or, more commonly, used as a neoadjuvant therapy prior to microsurgery or stereotactic radiosurgery. In contrast to the transarterial approach, curative embolization of AVMs may be more readily achieved from a transvenous approach. Transvenous embolization is considered a salvage therapy in contemporary AVM management. Proposed indications for this approach include a small (diameter < 3 cm) and compact AVM nidus, deep AVM location, hemorrhagic presentation, single draining vein, lack of an accessible arterial pedicle, exclusive arterial supply by perforators, and en passage feeding arteries. Available studies of transvenous AVM embolization in the literature have reported high complete obliteration rates, with reasonably low complication rates. However, evaluating the efficacy and safety of this approach is challenging due to the limited number of published cases. In this review the authors describe the technical considerations, indications, and outcomes of transvenous AVM embolization.
脑动静脉畸形（AVM）的血管内栓塞治疗传统上采用经动脉入路。经动脉 AVM 栓塞治疗可以作为一种单独的治疗方法，也更常见的是作为显微手术或立体定向放射外科治疗前的新辅助治疗。与经动脉入路相反，从经静脉途径更易于实现 AVM 的根治性栓塞。在当代 AVM 管理中，经静脉栓塞治疗被认为是一种挽救性治疗。该方法的适应证包括：小（直径 < 3cm）且致密的 AVM 病灶、深部 AVM 位置、出血表现、单一引流静脉、缺乏可接近的动脉蒂、单纯由穿支动脉供血、过路性供血动脉。文献中关于经静脉 AVM 栓塞治疗的研究报告显示，完全闭塞率较高，并发症发生率相对较低。然而，由于发表的病例数量有限，评估该方法的疗效和安全性具有挑战性。在这篇综述中，作者描述了经静脉 AVM 栓塞治疗的技术要点、适应证和结果。
