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Journal of Neurosurgical Sciences 2018 Mar 26

DOI: 10.23736/S0390-5616.18.04421-1


lingua: Inglese

Contemporary endovascular techniques for the curative treatment of cerebral arteriovenous malformations and review of neurointerventional outcomes

Pascal J. MOSIMANN 1 , René CHAPOT 2

1 Department of Diagnostic And Interventional Neuroradiology, Inselspital, Bern, Switzerland; 2 Department of Diagnostic And Interventional Neuroradiology, Essen, Germany


INTRODUCTION: Since the first landmark randomized trials on unruptured bAVMs were published, there has been emerging concerns about the role of endovascular therapy. For bAVMs considered inoperable, embolization remains an option worth considering, especially in young patients presenting with a rupture. We aimed to review the curative potential of contemporary stand-alone embolization techniques enabling high occlusion rates and their respective short and long term safety profile.
PATIENTS AND METHODS: We performed a PubMed search with the terms “curative embolization of brain arteriovenous malformations” and “endovascular cure of brain arteriovenous malformations” focusing on the last ten years (2008-2018) and compliant to the PRISMA reporting guidelines. We then screened the prospective and retrospective studies of pediatric or adult populations that contained patient demographics, ruptured or unruptured presentation, and bAVM grade according to the Spetzler-Martin (SM) classification. , exclusive or stand-alone endovascular treatment without previous embolization, micro-, radio- or stereotactic surgery, number of sessions, type of access, technique(s) and embolic agents used, rate of angiographically confirmed complete occlusion at least 3 months after obliteration stratified by AVM grade or subtype, as well as neurological status and treatment-associated outcome based on the modified Rankin scale at admission, discharge and within 12 months following curative embolization, rated by an independent observer.
RESULTS: Given the heterogeneity of the reported data, multiple confounding factors, overwhelming number of unpowered studies, lack of homogenous control groups and poor compliance to PRISMA reporting guidelines in most of the interventional literature, we were unable to obtain solid data and perform a statistical meta- analysis on the safety and effectiveness of curative embolization. Consequently, we decided to cover a selection of salient topics.
CONCLUSIONS: Stand-alone curative embolization, as well as exclusive microsurgery or radiosurgery each play complementary roles. Hemorrhagic, deep-seated lesions are an interesting subtype of surgically unfavorable bAVMs that may benefit from exclusive transvenous embolization, when carefully selected. Larger randomized trials and prospective registries are needed to establish the place of stand-alone or neoadjuvant endovascular treatment.

KEY WORDS: Brain arteriovenous malformations - AVM - Curative embolization - Endovascular treatment - Onyx - Squid - PHIL - Histoacryl - ARUBA

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Publication History

Article first published online: March 26, 2018
Manuscript accepted: March 8, 2018
Manuscript received: March 6, 2018

Per citare questo articolo

Mosimann PJ, Chapot R. Contemporary endovascular techniques for the curative treatment of cerebral arteriovenous malformations and review of neurointerventional outcomes. J Neurosurg Sci 2018 Mar 26. DOI: 10.23736/S0390-5616.18.04421-1

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