gms | German Medical Science

Endovascular treatment of AVMs is an established tool in the multimodal management of AVMs in combination with neurosurgery or radiosurgery. The rate of complete elemination by embolization is still controversely discussed. In the last few years, new embolic agents have been presented that suggest that they are superior to histoacryl, and raises the question: Is histoacryl still state-of-the-art?

In a three years period, 53 patients with cerebral AVMs underwent endovascular therapy. We report our experience with intracompartimental histoacryl application, in some cases combined with particles and microcoils, and where necessary, by multicatheter access, as described by Valavanis.

A total of 116 procedures were performed. Small and medium-sized AVMs (Spetzler Grade I n=1, Grade II, n= 13, Grade III, n= 17) could be occluded or significantly size-reduced in one or two sessions. Large AVMs (Spetzler Grade IV and V; n=18) underwent three to eight interventions. Four AVMs were located in the thalamus and brainstem. The complications include one postprocedural hemorrhage after six hours and two delayed bleedings after 5 and 7 days. The microcatheter was glued in the AVM and left in place in two cases without ischemic problems. Complete occlusion by the endovascular therapy alone was achieved in 21 patients, which is about 50 %. Morbitity and Mortality were 3 and 4%, respectively. Twenty-six patients underwent surgery (10) and radiosurgery (16) after endovascular therapy.

The technique of intracompartimental and intranidal histoacryl application via small microcatheters is still state-of-the-art. It improves the results of endovascular therapy clearly, and results in a 50 % rate of complete occlusions, even in large and complex AVMs (Spetzler Grade III-V).