Embolization of the nidus of brain arteriovenous malformations with n-butyl cyanoacrylate.
OBJECTIVE
To demonstrate that nidus embolization of brain arteriovenous malformations (AVMs) with Histoacryl (B. Braun, Melsungen, Germany) is effective and yields low morbidity and mortality rates.


METHODS
We present a retrospective analysis of 54 brain AVMs treated at the University of Illinois at Chicago from April 1994 to December 1995. Treatment modalities included embolization in all cases and then surgical resection or radiosurgery.


METHODS
The nidus was reached with the combined use of a Magic microcatheter (Balt, Montmorency, France) and a Terumo 0.010-inch guidewire.


METHODS
Embolization was performed only when the tip of the microcatheter was wedged into the nidus of the AVMs with no reflux of contrast proximally. The embolization was performed using simultaneous biplane roadmapping with the patient under general anesthesia without Amytal testing.


RESULTS
Twenty-six of 54 patients are still waiting for more radical treatment. Two deaths and two minor and one severe permanent neurological deficit occurred. Three patients were cured with embolization alone; 11 patients were cured after surgical resection. Three patients underwent radiosurgery, with one cure after 1 year.


CONCLUSIONS
Nidus embolization with Histoacryl is an effective technique that permits complete cure of a large number of brain AVMs, with or without surgical resection and/or radiosurgery.
Debrun
G M
GM
Department of Radiology and Neurosurgery, University of Illinois at Chicago, USA.
Aletich
V
V
Ausman
J I
JI
Charbel
F
F
Dujovny
M
M
D000293:Adolescent; D000328:Adult; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D003399:Craniotomy; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004659:Enbucrilate / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D016634:Radiosurgery; D015996:Survival Rate; D016896:Treatment Outcome
D004659:Enbucrilate