Complications of preoperative embolization of cerebral arteriovenous malformations.
OBJECTIVE
Preoperative embolization is viewed by the authors as a useful adjunct in the surgical management of cerebral arteriovenous malformations (AVMs). This study was performed to determine the rate of significant complication in patients undergoing this procedure.


METHODS
Demographic, anatomical, and procedure data were collected prospectively. The treating physician reported complications. In addition, a review of medical records including procedure reports, operative reports, and discharge summaries was performed. Univariate statistical analysis was performed to determine if any of the variables was predictive of a poor outcome of embolization (death or permanent neurological deficit). Endovascular procedures for embolization were performed 339 times in 201 patients during an 11-year period. Female patients comprised 53.7% of the study group and 85.6% of the AVMs were supratentorial. Embolization was performed using polyvinyl alcohol particles, N-butyl cyanoacrylate, detachable coils, and/or the liquid polymer Onyx. Analyzed by procedure, a poor result of embolization occurred in 7.7%. Analyzed by patient, 11% died or had a permanent neurological deficit as a result of the embolization. None of the demographic, anatomical, or procedure variables identified were predictive of a poor outcome.


CONCLUSIONS
Preoperative embolization may gradually reduce flow to an AVM, reduce intraoperative blood loss, and reduce operative time. The risks of this procedure, however, are not insignificant and must be considered in planning treatment for patients with AVMs.
Taylor
Christopher L
CL
Department of Neurological Surgery, The University of Southwestern Texas Medical Center, Dallas, Texas 75390-8855, USA. christopher.taylor@utsouthwestern.edu
Dutton
Kim
K
Rappard
George
G
Pride
G Lee
GL
Replogle
Robert
R
Purdy
Phillip D
PD
White
Jonathan
J
Giller
Cole
C
Kopitnik
Thomas A
TA
Samson
Duke S
DS
D000293:Adolescent; D000328:Adult; D000368:Aged; D001925:Brain Damage, Chronic / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000401:mortality; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality*; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013781:Texas