title: Embolization of the choroidal artery in the treatment of cerebral arteriovenous malformations.
abstract: OBJECTIVE The anterior and posterior choroidal arteries are often recruited to supply arteriovenous malformations (AVMs) involving important paraventricular structures, such as the basal ganglia, internal capsule, optic radiation, lateral geniculate body, and medial temporal lobe. Endovascular embolization through these arteries is theoretically dangerous because they supply eloquent territories, are of small caliber, and lack collaterals. This study aimed to investigate the safety and efficacy of embolization through these arteries. METHODS This study retrospectively reviewed 13 patients with cerebral AVMs who underwent endovascular embolization through the choroidal arteries between 2006 and 2014. Embolization was performed as a palliative procedure before open surgery or Gamma Knife radiosurgery. Computed tomography and MRI were performed the day after embolization to assess any surgical complications. The incidence and type of complications and their association with clinical outcomes were analyzed. RESULTS Decreased blood flow was achieved in all patients after embolization. Postoperative CT detected no hemorrhagic complications. In contrast, postoperative MRI detected that 4 of the 13 patients (30.7%) developed infarctions: 3 patients after embolization through the anterior choroidal artery, and 1 patient after embolization through the lateral posterior choroidal artery. Two of the 4 patients in whom embolization was from the cisternal segment of the anterior choroidal artery (proximal to the plexal point) developed symptomatic infarction of the posterior limb of the internal capsule, 1 of whom developed morbidity (7.7%). The treatment-related mortality rate was 0%. Additional treatment was performed in 12 patients: open surgery in 9 and Gamma Knife radiosurgery in 3 patients. Complete obliteration was confirmed by angiography at the last follow-up in 10 patients. Recurrent bleeding from the AVMs did not occur in any of the cases during the follow-up period. CONCLUSIONS Ischemic complications are possible following the embolization of cerebral AVMs through the choroidal artery, even with modern neurointerventional devices and techniques. Although further study is needed, embolization through the choroidal artery may be an appropriate treatment option when the risk of surgery or radiosurgery is considered to outweigh the risk of embolization.
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai;|Neuroendovascular Section, Department of Neurology, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Alaa
authors.initials: A
authors.lastname: Elkordy
authors.affiliation: Departments of 2 Neurosurgery and.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Endo
authors.affiliation: Neuroendovascular Therapy, Kohnan Hospital, Sendai.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sato
authors.affiliation: Neuroendovascular Therapy, Kohnan Hospital, Sendai.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Japan; and.
authors.forename: Ryushi
authors.initials: R
authors.lastname: Kondo
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai;
authors.forename: Kuniyasu
authors.initials: K
authors.lastname: Niizuma
authors.affiliation: Departments of 2 Neurosurgery and.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Endo
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai;
authors.forename: Miki
authors.initials: M
authors.lastname: Fujimura
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai;
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D004621:Embolization, Therapeutic; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: AChA = anterior choroidal artery; AVM = arteriovenous malformation; DWI = diffusion-weighted imaging; GK = Gamma Knife; ICA = internal carotid artery; LPChA = lateral posterior choroidal artery; NBCA = N-butyl cyanoacrylate; PChA = posterior choroidal artery; arteriovenous malformation; choroidal artery; complications; embolization; interventional neurosurgery; vascular disorders