PT  - JOURNAL ARTICLE
AU  - Dinark Conceição Viana
AU  - Luis Henrique de Castro-Afonso
AU  - Guilherme Seizem Nakiri
AU  - Lucas Moretti Monsignore
AU  - Felipe Padovani Trivelato
AU  - Benedicto Oscar Colli
AU  - Daniel Giansante Abud
TI  - Extending the indications for transvenous approach embolization for superficial brain arteriovenous malformations
AID  - 10.1136/neurintsurg-2017-013113
DP  - 2017 Nov 01
TA  - Journal of NeuroInterventional Surgery
PG  - 1053--1059
VI  - 9
IP  - 11
4099  - http://jnis.bmj.com/content/9/11/1053.short
4100  - http://jnis.bmj.com/content/9/11/1053.full
SO  - J NeuroIntervent Surg2017 Nov 01; 9
AB  - 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.