Endovascular Management of Deep Arteriovenous Malformations: Single Institution Experience in 22 Consecutive Patients

Neurosurgery. 2016 Jan;78(1):34-41. doi: 10.1227/NEU.0000000000000982.


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.

Conclusion: 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.

MeSH terms

  • Adult
  • Basal Ganglia / diagnostic imaging
  • Basal Ganglia / surgery
  • Cerebral Cortex / diagnostic imaging
  • Cerebral Cortex / surgery
  • Cohort Studies
  • Combined Modality Therapy
  • Disease Management*
  • Endovascular Procedures / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Arteriovenous Malformations / diagnostic imaging*
  • Intracranial Arteriovenous Malformations / surgery*
  • Male
  • Middle Aged
  • Prospective Studies
  • Radiography
  • Thalamus / diagnostic imaging
  • Thalamus / surgery
  • Treatment Outcome