In order to determine possible risk factors and to assess the value of
platinum microcoils added to
polyvinyl alcohol particles in preoperative embolization of
cerebral arteriovenous malformations in adults, we reviewed our experience with this procedure. Between September 1985 and June 1989, we performed embolizations in 54 patients with
cerebral arteriovenous malformations. Of these, procedures in 51 adults involved the use of
polyvinyl alcohol particles, either alone (n = 29) or in combination with
platinum microcoils (n = 21). A complication during catheterization precluded embolization in another patient. Beginning as flow-directed embolizations via carotid artery catheterizations (n = 12), newer
catheters allowed progression to superselective intracerebral catheterizations (n = 38). Embolization has led to shorter
surgical procedures, more clearly defined operative margins, and less bloody operative fields. We have not found recanalization to significantly hinder embolization results with
polyvinyl alcohol when resection is undertaken within 1-4 weeks of embolization. Its relative safety and ease of manipulation at surgery argue for its use. We found no significant increase in complications based on patient age, venous drainage of the
arteriovenous malformation, or the circulation embolized. Embolization results in
cerebral arteriovenous malformations were improved with superselective catheterization and most improved with the combined use of
polyvinyl alcohol for nidus embolization followed by occlusion of the feeding vessel with microcoils.