title: Intracranial dural arteriovenous shunts: transarterial glue embolization--experience in 115 consecutive patients.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of transarterial glue embolization of intracranial dural arteriovenous shunts (DAVS).
  
  
  METHODS
  Institutional review board approval was obtained, with waiver of informed consent, for this retrospective study. From a single-center database of information on 371 intracranial DAVS, data in 115 consecutive patients treated with transarterial glue embolization were identified and assessed. Clinical and angiographic features, including cure rate, complications, and outcome, were evaluated. The treatment results were also compared between the patients in the first half of the consecutive series and those in the second half. The mean glue concentrations used were compared between the first and second halves of the patient series by using the Student t test.
  
  
  RESULTS
  One hundred twenty-one lesions were treated with transarterial glue embolization. There were 31 (25.6%) Borden type I lesions, 39 (32.2%) Borden type II lesions, and 51 (42.1%) Borden type III lesions. Angiographic cure with glue embolization was achieved for 36 lesions (29.8%); 17 (14.0%) lesions were cured immediately, and 19 (15.7%) showed progressive thrombosis at follow-up. The angiographic cure rate for Borden type III lesions improved from 10% to 55% in the later group of patients as compared with the earlier group. The mean concentration of glue was significantly lower in the later group of patients. One (0.9%) of the 115 patients suffered permanent morbidity from aggravation of left extremity weakness due to venous thrombosis. Eight patients experienced nonpermanent morbidities, including transient worsening of neurologic status due to venous thrombosis (n = 4), alopecia (n = 2), scalp ulcer (n = 1), and pulmonary embolism (n = 1). Overall, improvement (n = 65) or stabilization (n = 32) of symptoms was seen in 84.3% of the patients.
  
  
  CONCLUSIONS
  Transarterial glue embolization is a safe and effective method of primary treatment for intracranial DAVS, especially Borden type III lesions. Improvement of cure rates in the latter half of this study suggest that technical advances and experience may enhance outcomes.
authors.affiliation: Department of Radiology, Yonsei University College of Medicine, Seoul, Korea. djkimmd@yuhs.ac
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Robert A
authors.initials: RA
authors.lastname: Willinsky
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
authors.forename: Ronit
authors.initials: R
authors.lastname: Agid
authors.forename: Karel
authors.initials: K
authors.lastname: Terbrugge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate