Embolization of Cerebral Arteriovenous Malformations with Cellulose Acetate Polymer: A Clinical, Radiological, and Histological Study

Embolization of Cerebral Arteriovenous Malformations with Cellulose Acetate Polymer: A Clinical,... AbstractOBJECTIVEA cellulose acetate polymer (CAP) solution was hypothesized to be useful for the embolization of arteriovenous malformations (AVMs). To investigate this possibility, we analyzed the clinical, radiological, and histological results of patients with AVMs embolized by using a CAP solution.METHODSWe reviewed the cases of 11 patients with AVMs treated by embolization before surgical resection. We used two types of CAP solutions, CAP-M and CAP-L, which are mixtures of 250 mg of solid CAP and 1800 or 2250 mg of bismuth trioxide dissolved in 5.5 or 7.0 ml of dimethyl sulfoxide, respectively. After the embolization procedure, percent reduction of the nidus volume was measured, and thereafter, the clinical course and computed tomographic scans and/or magnetic resonance imaging scans were evaluated. All patients underwent surgical resection 1 to 51 days after embolization. Resected specimens were stained for light microscopic examination.RESULTSThirty-nine feeding vessels were embolized. The reduction rate of the nidus volume ranged from 20% to nearly 100%. Transient and persistent ischemic deficits occurred in three patients and one patient, respectively, and there were no hemorrhagic complications. All AVMs but one were completely resected by surgery. The embolized AVMs were soft enough to be easily cut and retracted. The histological examinations disclosed no or mild inflammatory reactions within 2 weeks after embolization. The internal elastic lamina was preserved in every case. Recanalization through the cast of the CAP mass was not observed until 51 days after embolization.CONCLUSIONCAP solution is a safe and useful embolic agent for AVMs. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Embolization of Cerebral Arteriovenous Malformations with Cellulose Acetate Polymer: A Clinical, Radiological, and Histological Study

Embolization of Cerebral Arteriovenous Malformations with Cellulose Acetate Polymer: A Clinical, Radiological, and Histological Study

Embolization of Cerebral Arteriovenous Malformations with Cellulose Acetate Polymer: A Clinical, Radiological, and Histological Study Koji Tokunaga, M .D ., Kazushi Kinugasa, M .D ., Sanami Kawacla, M .D ., Hiroyuki Nakashima, M .D ., Takashi Tamiya, M .D ., Nobuyuki Hirotsune, M .D ., Shinya Mandai, M .D ., Takashi Ohmoto, M .D. D e p a r t m e n t o f N e u r o l o g i c a l S u r g e r y (K T , S K , H N , T T , T O ) , O k a y a m a U n i v e r s i t y M e d i c a l S c h o o l , a n d O k a y a m a R e h a b ilit a t io n C e n t e r fo r T r a u m a t ic A p a l l i c s (K K , N H ) , O k a y a m a ; a n d D e p a r t m e n t o f N e u r o s u r g e r y ( S M ) , K a g a w a P r e f e c t u r a l C e n t r a l H o s p it a l, K a g a w a , Ja p a n OBJECTIVE: A cellulose acetate polymer (CAP) solution was hypothesized to be useful for the embolization of arteriovenous malformations (AVMs). To investigate this possibility, we analyzed the clinical, radiological, and histological results of patients with AVM s embolized by using a CA P solution. METHODS: W e reviewed the cases of 11 patients with AVMs treated by embolization before surgical resection. W e used two types of CAP solutions, CAP-M and CAP-L, which are mixtures of 250 mg of solid CAP and 1800 or 2250 mg of bismuth trioxide dissolved in 5.5 or 7.0 ml of dimethyl sulfoxide, respectively. After the embolization procedure, percent reduction of the nidus volume was measured, and thereafter, the clinical course and computed tomographic scans and/or magnetic resonance imaging scans were evaluated. All patients underwent surgical resection 1 to 51 days after embolization. Resected specimens were stained for light microscopic examination. RESULTS: Thirty-nine feeding vessels were embolized. The reduction rate of the nidus volume ranged from 2 0 % to nearly 1 0 0 % . Transient and persistent ischem ic deficits occurred in three patients and one patient, respectively, and there were no hemorrhagic...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199905000-00026
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVEA cellulose acetate polymer (CAP) solution was hypothesized to be useful for the embolization of arteriovenous malformations (AVMs). To investigate this possibility, we analyzed the clinical, radiological, and histological results of patients with AVMs embolized by using a CAP solution.METHODSWe reviewed the cases of 11 patients with AVMs treated by embolization before surgical resection. We used two types of CAP solutions, CAP-M and CAP-L, which are mixtures of 250 mg of solid CAP and 1800 or 2250 mg of bismuth trioxide dissolved in 5.5 or 7.0 ml of dimethyl sulfoxide, respectively. After the embolization procedure, percent reduction of the nidus volume was measured, and thereafter, the clinical course and computed tomographic scans and/or magnetic resonance imaging scans were evaluated. All patients underwent surgical resection 1 to 51 days after embolization. Resected specimens were stained for light microscopic examination.RESULTSThirty-nine feeding vessels were embolized. The reduction rate of the nidus volume ranged from 20% to nearly 100%. Transient and persistent ischemic deficits occurred in three patients and one patient, respectively, and there were no hemorrhagic complications. All AVMs but one were completely resected by surgery. The embolized AVMs were soft enough to be easily cut and retracted. The histological examinations disclosed no or mild inflammatory reactions within 2 weeks after embolization. The internal elastic lamina was preserved in every case. Recanalization through the cast of the CAP mass was not observed until 51 days after embolization.CONCLUSIONCAP solution is a safe and useful embolic agent for AVMs.

Journal

NeurosurgeryOxford University Press

Published: May 1, 1999

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