title: Endovascular Management of Deep Arteriovenous Malformations: Single Institution Experience in 22 Consecutive Patients.
abstract: BACKGROUND
  The management of arteriovenous malformations (AVMs) in the basal ganglia, insula, and thalamus is demanding for all treatment modalities.
  
  
  OBJECTIVE
  To define safety and outcomes of embolization used as a stand-alone therapy for deep-seated AVMs.
  
  
  METHODS
  A cohort of 22 patients with AVMs located in the basal ganglia, thalamus, and insula who underwent embolization between January 2008 and December 2013.
  
  
  RESULTS
  Eighteen of 22 (82%) patients had anatomic exclusion. The mean size was 2.98 ± 1.28 cm, and the mean number of sessions was 2.1 per patient. Most patients presented with hemorrhage (82%, n = 18), and 3 (14%) patients were in a deteriorated neurological status (modified Rankin Scale >2) at presentation. Sixty-eight percent of ruptured AVMs had size ≤3 cm. A single transarterial approach was performed in 9 (41%) cases, double catheterization was used in 4 (18%), and the transvenous approach was required in 8 (36%) cases. Procedure-related complications were registered in 3 (14%) cases. One death was associated with treatment, and complementary radiosurgery was required in 2 (9%) patients.
  
  
  CONCLUSIONS
  Embolization therapy appears to be safe and potentially curative for certain deep AVMs. Our results demonstrate a high percentage of anatomic obliteration with rates of complications that may approach radiosurgery profile. In particular, embolization as stand-alone therapy is most suitable to deep AVMs with small nidus size (≤3 cm) and/or associated with single venous drainage in which microsurgery might not be indicated.
authors: *Department of Interventional Neuroradiology, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France;‡Department of Neurosurgery, Hôpital Dupuytren, Centre Regional Hospitalier Universitaire de Limoges, Limoges, France.
authors: George A C
authors: GA
authors: Mendes
authors: Eduardo Pedrolo
authors: EP
authors: Silveira
authors: François
authors: F
authors: Caire
authors: Marie-Paule
authors: MP
authors: Boncoeur Martel
authors: Suzana
authors: S
authors: Saleme
authors: Christina
authors: C
authors: Iosif
authors: Charbel
authors: C
authors: Mounayer
mesh_terms: D000328:Adult; D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000601:surgery; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D019468:Disease Management; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013788:Thalamus / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome