ABSTRACT
This study investigated the effect and safety of targeted embolization in partially embolized cerebral arteriovenous malformation (AVM) followed by gamma knife surgery (GKS). We retrospectively analyzed 86 AVM patients who were targeted embolized by Onyx followed by GKS for residual nidus. Embolization-related complications were collected and the clinical effect was evaluated. During targeted embolization, intranidus or hemodynamic aneurysms and AVM-related fistula were evaluated and targeted embolized. Patients with AVM-related aneurysms and fistula were divided into a targeted embolization group and non-targeted embolization group based on the retrospectively determined treatment strategy. The effect of targeted embolization on hemorrhage risk was evaluated. The overall annual hemorrhage rate was 1.66% with 2.26% for ruptured AVMs and 1.08% for unruptured lesions. The annual mortality rate was 0.4%. Only one in 16 patients with embolization-related complications had permanent neurologic deficit. Twenty-four of 29 cases with intranidus aneurysms were targeted embolized, four of five cases with hemodynamic aneurysms were targeted embolized and eight of nine cases with arteriovenous fistula were targeted embolized. Chi square results showed the hemorrhage complications in the target embolization group were significantly lower than those in the non-target embolization group (p < 0.01). Targeted embolization combined with GKS treatment decreased the annual hemorrhage rate and improved clinical outcome with low permanent complications in partially embolized AVMs. This method could be proposed for the treatment of large brain AVMs when a single-technique treatment is not feasible.
Subject(s)
Cerebral Hemorrhage/therapy , Electrosurgery , Embolization, Therapeutic , Intracranial Arteriovenous Malformations/therapy , Adolescent , Adult , Cerebral Hemorrhage/etiology , Child , Combined Modality Therapy , Electrosurgery/adverse effects , Electrosurgery/instrumentation , Embolization, Therapeutic/adverse effects , Female , Humans , Intracranial Arteriovenous Malformations/complications , Male , Middle Aged , Retrospective Studies , Vascular Surgical Procedures/instrumentation , Vascular Surgical Procedures/methods , Young AdultABSTRACT
Giant serpentine aneurysms have recently been successfully treated with endovascular parent artery occlusion with or without distal by-pass. This report retrospectively analyses the outcome of endovascular parent artery occlusion for intracranial giant serpentine aneurysms. Medical records and cerebral angiograms from our endovascular center were analyzed retrospectively. Five patients with serpentine aneurysms were treated by endovascular occlusion of the parent artery at the site of the aneurysm. These patients had selective treatment. The clinical and angiographic outcomes in five patients were assessed at three months to three years. No cerebral infarction occurred. Of the patients, five made excellent recoveries at follow-up. No recurrence or rebleeding was noted. Endovascular parent artery occlusion may be a safe and effective way to treat intracranial giant serpentine aneurysms.
ABSTRACT
We describe a patient with dural arterial venous fistula of the cavernous sinus causing occulomotor palsy and chemosis. The fistula was successfully treated via transvenous approach with Onyx-18 and detachable platinum coils.
ABSTRACT
We describe the first case of a dural arteriovenous fistula of the anterior cranial fossa successfully treated with transarterial embolization using Onyx-18.
ABSTRACT
Paper Withdrawn Because Already Published in AJNR American Journal of Neuroradiology 28: 1769 - 70 - October 2007.
