title: Preoperative silk suture embolization of cerebral and dural arteriovenous malformations.
abstract: OBJECTIVE
  The aim of this study was to evaluate the use of silk sutures as a medical implant when applied for the embolization of cerebral and dural arteriovenous malformations (AVMs). The facility of surgery and the clinical significance of complications related to preoperative silk suture embolization were evaluated immediately after surgery and at long-term follow up.
  
  
  METHODS
  Thirty-four patients harboring 29 cerebral and five dural AVMs underwent embolization in which silk alone or in association with other agents was used. Medical and radiological records obtained in these 34 patients were reviewed retrospectively. The cerebral AVMs were classified according to the Spetzler-Martin grading system and the dural AVMs to the Djindjian grading system. The facility of the resection and the adverse outcomes, including new neurological deficits, hemorrhage, and fever, as well as histopathological evidence of vessel inflammatory changes, were determined in each case. In all 23 surgical cases, the AVM could be easily manipulated and excised. New temporary neurological deficits occurred in three patients. A high Spetzler-Martin grade was not associated with a higher incidence of new neurological deficits. One delayed-onset hemorrhage was detected after embolization. Fever was present in 24% of the patients. No sign of significant vasculitis or perivascular inflammation was found on radiological or histopathological examination.
  
  
  CONCLUSIONS
  Silk sutures are safe embolic agents especially for proximal occlusion of AVM feeding vessels. New permanent neurological deficits were not encountered in this series. Fever was considered to be a minor, temporary side effect of silk suture embolization.
authors.affiliation: Division of Neuroradiology, Department of Neurosurgery, University Hospital of Geneva, Switzerland. ardi@hcuge.ch
authors.forename: A R
authors.initials: AR
authors.lastname: Dehdashti
authors.forename: M
authors.initials: M
authors.lastname: Muster
authors.forename: A
authors.initials: A
authors.lastname: Reverdin
authors.forename: N
authors.initials: N
authors.lastname: de Tribolet
authors.forename: D A
authors.initials: DA
authors.lastname: Ruefenacht
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000601:surgery / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D003131:Combined Modality Therapy; D003487:Cyanoacrylates / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004659:Enbucrilate; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008670:Metals; D008863:Microspheres; D008875:Middle Aged; D011142:Polyvinyl Alcohol / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods*; D011859:Radiography; D016634:Radiosurgery; D012008:Recurrence; D012189:Retrospective Studies; D047011:Silk; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates; D008670:Metals; D047011:Silk; D011142:Polyvinyl Alcohol; D004659:Enbucrilate