Absolute ethanol in treatment of brain arteriovenous malformations / 中华放射学杂志

ABSTRACT

Objective:To investigate the feasibility of absolute ethanol in the treatment of brain arteriovenous malformation (bAVM).Methods:The clinical data of 25 patients with bAVM treated with absolute ethanol in the specialty of intracranial vascular malformations in Henan Provincial People′s Hospital from September 2018 to May 2019 were retrospectively analyzed. There were 14 males and 11 females, aged 7-62 years, with a median age of 26 years. Among the 25 patients, 18 cases had ruptured bAVM, 7 cases had unruptured bAVM. Spezler-Martin grade<Ⅲ were found in 14 cases, Ⅲ grade in 7 cases, and >Ⅲ grade in 4 cases. The clinical effect and perioperative complications were observed.Results:Among 25 patients, the overall technical success rate was 96.0% (24/25), one of which the target lesion with anhydrous ethanol could not be ablated. The overall complication rate was 28.0% (7/25) with no death. All complications were ischemic, and the incidence of severe complications was 12.0% (3/25). Twenty-five patients were followed up 3 months after the operation, 4 of which had mild complications, 2 recovered completely and 2 made reasonable recovery. In the 3 patients with severe complications, 2 patients made reasonable recovery and 1 patient had significant improvement. The modified rankin scale (MRS) score of all patients with complications was ≤2, and the remaining 18 patients had no new onset clinical symptoms. Thirteen patients were followed up by DSA and MRI. DSA showed no recurrence in the lesions ablated by absolute ethanol. In 2 patients with partial residual malformation after operation, the residual deformities disappeared completely at the time of reexamination. MRI showed that brain edema disappeared in all patients.Conclusions:The ablation of absolute ethanol in bAVM has a high operation success rate, definite clinical effect and low recurrence rate of postoperative bAVM. It can be used as an exploratory treatment.