Fractionated embolization for the treatment of large cerebral arteriovenous malformation：clinical experience in 35 cases / 介入放射学杂志

ABSTRACT

Objective To discuss the therapeutic methods and strategies of fractionated embolization in treating large cerebral arteriovenous malformation (cAVM). Methods During the period from May 2005 to May 2013 at authors’ hospital, endovascular fractionated embolization was performed in 35 cases with large cAVM. The lesions were located in the frontal lobe (n = 11), the parietal lobe(n = 8), the temporal lobe (n = 6), the occipital lobe (n = 4), the lateral temporal area (n = 2) and the deep white matter and basal ganglia (n = 4). The longest diameter of the lesions was 6 - 12 cm, with a mean of 7.23 cm. The number of supply vessels was 2 - 5. The lesions were drained by superficial veins in 13 cases, by deep veins in 9 cases and by both superficial and deep veins in 17 cases. The exit stenosis of the draining vein was seen in 3 cases, while the dilatation of the draining vein was found in 6 cases. Angiography showed that the lesions were situated at the right side in 16 cases and at the left side in 19 cases. Results A total of 297 times of embolization operating-process were carried out in the 35 patients, of which NBCA was used in 107, ONYX in 153 with, FuAiLe medical adhesive in 15, combination use of NBCA and ONYX in 9 and combination use of ONYX and FuAiLe medical adhesive in 13. No death occurred after treatment. After the first embolization, the residual malformation volume usually decreased to 80%embolization) in 9 patients. Good recovery was achieved in all patients. After fractionated embolization, the volume of the cAVMs was decreased gradually and ultimate clinical cure was achieved, which laid the foundation for conducting further micro - neruosurgery or radiation therapy. Conclusion For the treatment of large cerebral arteriovenous malformation, fractionated embolization has reliable therapeutic effect. Therefore, this technique should be recommended in clinical practice.