Embolization of Basal Ganglia and Thalamic Arteriovenous Malformations

Embolization of Basal Ganglia and Thalamic Arteriovenous Malformations AbstractOBJECTIVEBasal ganglia and thalamic arteriovenous malformations (AVMs) show a poor natural history and have proven difficult to treat. We report the safety and efficacy of presurgical and preradiosurgical embolization of these deep central lesions and describe the contribution of embolization to multimodality treatment.METHODSThirty-eight patients with basal ganglia and/or thalamic AVMs underwent embolization in a total of 69 sessions. Seven of the 38 patients (18.4%) presented with hemorrhage, and 23 of 38 (60.5%) exhibited neurological deficits before therapy. Thirty patients (78.9%) underwent embolization with a liquid adhesive (cyanoacrylate), and five of these patients also underwent embolization with polyvinyl alcohol. Five patients (13.2%) were treated with polyvinyl alcohol or polyvinyl alcohol and silk. One patient (2.6%) underwent embolization alone, 19 (50.0%) underwent embolization followed by radiosurgery, 5 (13.2%) underwent embolization plus microsurgical resection, and 13 (34.2%) patients were treated using all three modalities.RESULTSThree patients did not undergo embolization because of the morphological features of the AVMs and poor endovascular access. The patients who underwent embolization achieved AVM volume reductions of 10 to 100% (mean, 49.7%). Fifteen patients (39,5%) achieved complete obliteration of their AVMs, one with embolization alone, three with embolization followed by radiosurgery, five with embolization plus microsurgical resection, and six with a combination of all three modalities. At the time of the last follow-up imaging session, embolization combined with radiosurgery (19 patients) yielded a mean volume reduction of 81.1 %, and all three modalities (13 patients) yielded a mean reduction of 84.6%. Four permanent neurological deficits resulted from embolization (5.8% of procedures, 10.5% of patients). The embolization-related complication rate was higher in the earlier years (1984-1989) of this series.CONCLUSIONEndovascular embolization plays an important role in multimodality treatment of AVMs involving the basal ganglia and/or thalamus. Embolization can result in obliteration of a significant volume of the AVM and may allow complete obliteration of the AVM when combined with microsurgical resection and/or stereotactic radiosurgery. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Embolization of Basal Ganglia and Thalamic Arteriovenous Malformations

Embolization of Basal Ganglia and Thalamic Arteriovenous Malformations

Embolization of Basal Ganglia and Thalamic Arteriovenous Malformations Richard D. Paulsen, M .D., Gary K. Steinberg, M .D ., Ph.D., Alexander M. Norbash, M .D ., Mary L. Marcellus, R.N., Michael P. Marks, M .D. D e p a r t m e n t s o f R a d i o l o g y ( R D P , A M N , M L M , M P M ) a n d N e u r o s u r g e r y ( G K S ) a n d S t a n f o r d S t r o k e C e n t e r ( R D P , G K S , A M N , M L M , M P M ) , S t a n f o r d U n i v e r s i t y M e d i c a l C e n t e r , S ta n fo r d , C a l i f o r n i a OBJECTIVE: Basal ganglia and thalam ic arteriovenous malformations (AVMs) show a poor natural history and have proven difficult to treat. W e report the safety and efficacy of presurgical and preradiosurgical embolization of these deep central lesions and describe the contribution of embolization to multimodality treatment. METHODS: Thirty-eight patients with basal ganglia and/or thalamic AVM s underwent embolization in a total of 69 sessions. Seven of the 38 patients (18.4% ) presented with hemorrhage, and 23 of 38 (60.5% ) exhibited neurological deficits before therapy. Thirty patients (78.9% ) underwent embolization with a liquid adhesive (cyanoacrylate), and five of these patients also underwent embolization with polyvinyl alcohol. Five patients (1 3 .2 % ) w ere treated with polyvinyl alcohol or polyvinyl alcohol and silk. O n e patient (2 .6 % ) underwent embolization alone, 19 (50.0%) underwent em bolization followed by radiosurgery, 5 (1 3 .2 % ) underwent embolization plus m icrosur­ gical resection, and 13 (3 4 .2 % ) patients w ere treated using all three modalities. RESULTS: Three patients did not undergo embolization because of the morphological features of the AVMs and poor endovascular access. The patients who underwent embolization achieved AVM volume reductions of 10 to 100% (mean, 49.7% ). Fifteen patients (39,5% ) achieved complete obliteration of their AVMs, one with embolization alone, three with embolization followed by...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199905000-00031
Publisher site
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Abstract

AbstractOBJECTIVEBasal ganglia and thalamic arteriovenous malformations (AVMs) show a poor natural history and have proven difficult to treat. We report the safety and efficacy of presurgical and preradiosurgical embolization of these deep central lesions and describe the contribution of embolization to multimodality treatment.METHODSThirty-eight patients with basal ganglia and/or thalamic AVMs underwent embolization in a total of 69 sessions. Seven of the 38 patients (18.4%) presented with hemorrhage, and 23 of 38 (60.5%) exhibited neurological deficits before therapy. Thirty patients (78.9%) underwent embolization with a liquid adhesive (cyanoacrylate), and five of these patients also underwent embolization with polyvinyl alcohol. Five patients (13.2%) were treated with polyvinyl alcohol or polyvinyl alcohol and silk. One patient (2.6%) underwent embolization alone, 19 (50.0%) underwent embolization followed by radiosurgery, 5 (13.2%) underwent embolization plus microsurgical resection, and 13 (34.2%) patients were treated using all three modalities.RESULTSThree patients did not undergo embolization because of the morphological features of the AVMs and poor endovascular access. The patients who underwent embolization achieved AVM volume reductions of 10 to 100% (mean, 49.7%). Fifteen patients (39,5%) achieved complete obliteration of their AVMs, one with embolization alone, three with embolization followed by radiosurgery, five with embolization plus microsurgical resection, and six with a combination of all three modalities. At the time of the last follow-up imaging session, embolization combined with radiosurgery (19 patients) yielded a mean volume reduction of 81.1 %, and all three modalities (13 patients) yielded a mean reduction of 84.6%. Four permanent neurological deficits resulted from embolization (5.8% of procedures, 10.5% of patients). The embolization-related complication rate was higher in the earlier years (1984-1989) of this series.CONCLUSIONEndovascular embolization plays an important role in multimodality treatment of AVMs involving the basal ganglia and/or thalamus. Embolization can result in obliteration of a significant volume of the AVM and may allow complete obliteration of the AVM when combined with microsurgical resection and/or stereotactic radiosurgery.

Journal

NeurosurgeryOxford University Press

Published: May 1, 1999

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