Endovascular management of deep arteriovenous malformations: Single institution experience in 22 consecutive patients

Abstract

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.