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Case series
Extending the indications for transvenous approach embolization for superficial brain arteriovenous malformations
  1. Dinark Conceição Viana1,
  2. Luis Henrique de Castro-Afonso1,
  3. Guilherme Seizem Nakiri1,
  4. Lucas Moretti Monsignore1,
  5. Felipe Padovani Trivelato1,
  6. Benedicto Oscar Colli2,
  7. Daniel Giansante Abud1
  1. 1 Division of Interventional Neuroradiology, Department of Internal Medicine, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
  2. 2 Division of Neurosurgery, Department of Surgery, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
  1. Correspondence to Dr Luis Henrique de Castro-Afonso, Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil, 14048-090; castroafonsolh{at}


Introduction Transarterial embolization is the standard endovascular treatment strategy for intracranial arteriovenous malformations (AVMs). The transvenous approach has been indicated for the embolization of deep AVMs meeting a set of strict eligibility criteria. The present study aims to assess the safety and efficacy of the transvenous approach for superficial AVMs.

Methods A retrospective series of 12 patients presenting with cortical AVMs were treated by endovascular embolization using a transvenous approach with a curative intent.

Results Nine patients (75%) had ruptured AVMs at admission. The mean nidus size was 1.9 cm, six patients (50%) had a nidus in eloquent areas and the median Spetzler–Martin grade was 2. The rate of immediate angiographic occlusion of the AVMs was 91.6% (11/12). One patient in whom immediate angiographic occlusion was not achieved showed spontaneous occlusion at the 6-month follow-up. No procedural or clinical complications were observed. The mean and median modified Rankin scale (mRS) scores at discharge were 1.7 and 2 (range 0–3, SD=0.96), and the mean and median mRS scores at 6 months were 1.6 and 2 (0–3, 1.16). Nine patients (75%) were independent (mRS ≤2) at discharge and 11 patients (91.6%) were independent (mRS ≤2) at the 6-month follow-up.

Conclusions The curative transvenous embolization of superficial intracranial AVMs is feasible and appears safe and effective when strict anatomical selection is respected. This technique extends the current indications for transvenous embolization of intracranial AVMs and may improve cure rates while reducing embolization-related complications.

  • Intracranial arteriovenous malformations
  • Onyx
  • Transvenous embolization.

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  • Contributors DCV contributed to the concept of the study and drafted and approved the manuscript. LHdCA contributed to the study concept and design, data analysis, revision and final approval of the manuscript. GSN, LMM, FPT and OBC contribution to data acquisition, figures and tables, revision and final approval of the manuscript. DGA contributed to the concept of the study, acquired data, critically revised the manuscript and approved the final work.

  • Competing interests None declared.

  • Ethics approval Our institutional ethics committee and Plataforma Brasil, number of CAAE: 61913414.5.0000.5440.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished or unprocessed data, protocols, or images are available upon request from the corresponding author.

  • Correction notice Since this paper was first published online an author’s name has been updated. Oscar Benedicto Colli has been corrected to read Benedicto Occar Colli.