[Endovascular treatment of intracranial arteriovenous malformation with n-butyl cyanoacrylate. Working methods and experience in 58 cases].

Abstract

BACKGROUND AND PURPOSE:

Arteriovenous malformations (AVMs) constitute malformative lesions of the central nervous system vasculature and cause significant morbidity and mortality. Endovascular embolization with n-butyl cyanoacrylate is a well established modality of AVM treatment, usually combined with surgery or radiosurgery. The purpose of this study was to characterise the AVMs that were treated endovascularly with n-butyl cyanoacrylate and to evaluate the post-embolization results in the Cuban population.

MATERIALS AND METHODS:

From February 2006 to February 2011, a group of 58 consecutive patients with brain AVMs were embolized using n-butyl cyanoacrylate in the endovascular therapy unit of the Medical Surgical Research Centre in Havana (Cuba). In all, 91sessions were carried out with intranidal embolization and mainly partial devascularization, 25-30% per session, and closing 123 arterial pedicles. Safety times for n-butyl cyanoacrylate injection were established by calculating the polymerisation times for different dilutions, using post-embolisation hypotension systematically, as well as a superselective test with propofol to determine cerebral eloquence.

RESULTS:

Haemorrhagic signs were the initial presentation in 68.8% of the patients, 24.1% presented with epileptic episodes and 1.7% with ischemic stroke. Of the AVMs, 93.2% were supratentorial; according to the Spetzler and Martin classification, 13.8% were grade II, 56.9% were grade III, 22.4% were grade IV and 6.8%, grade V. One hundred and twenty-eight selective tests with propofol were performed and 118 (92.2%) of those were negative. Partial devascularization (20-30%) prevailed; complete obliteration was achieved in 17.2% of the patients and 70%-99% in 27.5% of the patients. Safety times for n-butyl cyanoacrylate injection were established and the use of post-procedure hypotension was settled. Morbidity of 17.2%, with 6.9% haemorrhagic complications and mortality of 3.4% were registered in the whole series.

CONCLUSIONS:

The rates of total occlusion and of morbidity and mortality in the series are in the internationally described ranges. The implementation of intranidal closings with 20-30% devascularization per session and the use of post-embolization hypotension after the haemorrhage complications described resulted in the total absence of haemorrhagic complications.

• Authors: José A Jordan González, Juan Carlos Llibre Guerra, José A Prince López, Frank Vázquez Luna, Raúl Marino Rodríguez Ramos, José Carlos Ugarte Suarez
• Journal: Neurocirugia (Asturias, Spain) (Neurocirugia (Astur)) 2013 May-Jun Vol. 24 Issue 3 Pg. 110-20 ISSN: 1130-1473 [Print] Spain
• Vernacular Title: Tratamiento endovascular de malformaciones arteriovenosas intracerebrales con n-butil cianoacrilato. Métodos de trabajo y experiencia en 58 casos.
• PMID: 23566543 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

Chemical References

• Tissue Adhesives
• Enbucrilate
• Propofol

Topics

• Adolescent
• Adult
• Aged
• Brain Ischemia (etiology)
• Cerebral Angiography
• Child
• Embolization, Therapeutic (adverse effects, methods)
• Enbucrilate (therapeutic use)
• Endovascular Procedures
• Epilepsy (etiology)
• Female
• Humans
• Intracranial Arteriovenous Malformations (complications, diagnostic imaging, therapy)
• Intracranial Hemorrhages (etiology)
• Intracranial Hypotension (etiology)
• Male
• Middle Aged
• Propofol
• Tissue Adhesives (therapeutic use)
• Young Adult