Arteriovenous malformations of the brain: Choosing embolic materials to enhance safety and ease of excision

P. D. Purdy, H. H. Batjer, R. C. Risser, D. Samson

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

The authors report their experience with surgical resection of 108 previously embolized arteriovenous malformations (AVM's). Embolization was performed via only transfemoral catheterization in 70 lesions and via the surgical exposure of feeding vessels in 32. The remaining six patients were referred for resection following silicone sphere embolization elsewhere. Materials used included polyvinyl alcohol (PVA) foam, platinum microcoils, detachable silicone balloons, surgical silk, a mixture of 33% ethanol and microfibrillar collagen, and isobutyl cyanoacrylate (IBCA). It is believed that proximal arterial occlusion with balloons is an inferior choice for preresection embolization, because the technical difficulty of placement is high and the nidus of the AVM is unaffected. Vascular coagulation and section and AVM retraction are more difficult with IBCA; therefore, this is also considered an inferior choice. Among the materials studied, the combination of PVA for distal occlusion and microcoils for proximal occlusion appears to be the superior choice. Fewer complications (stroke or hemorrhage) are seen when intraarterial Amytal (amobarbital) testing is used to guide the embolization. Data regarding toxicity, oncogenicity, and vascular metabolism or recanalization associated with PVA, IBCA, and n-butyl cyanoacrylate are reviewed.

Original languageEnglish (US)
Pages (from-to)217-222
Number of pages6
JournalJournal of Neurosurgery
Volume77
Issue number2
StatePublished - 1992

Fingerprint

Bucrylate
Arteriovenous Malformations
Amobarbital
Polyvinyl Alcohol
Silicones
Safety
Blood Vessels
Brain
Cyanoacrylates
Balloon Occlusion
Silk
Platinum
Catheterization
Ethanol
Collagen
Stroke
Hemorrhage

Keywords

  • arteriovenous malformation
  • cerebrovascular system
  • cyanoacrylate
  • embolization
  • polyvinyl alcohol

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Arteriovenous malformations of the brain : Choosing embolic materials to enhance safety and ease of excision. / Purdy, P. D.; Batjer, H. H.; Risser, R. C.; Samson, D.

In: Journal of Neurosurgery, Vol. 77, No. 2, 1992, p. 217-222.

Research output: Contribution to journalArticle

@article{dcdc96b1b2764362aa50f9cdf0d694cd,
title = "Arteriovenous malformations of the brain: Choosing embolic materials to enhance safety and ease of excision",
abstract = "The authors report their experience with surgical resection of 108 previously embolized arteriovenous malformations (AVM's). Embolization was performed via only transfemoral catheterization in 70 lesions and via the surgical exposure of feeding vessels in 32. The remaining six patients were referred for resection following silicone sphere embolization elsewhere. Materials used included polyvinyl alcohol (PVA) foam, platinum microcoils, detachable silicone balloons, surgical silk, a mixture of 33{\%} ethanol and microfibrillar collagen, and isobutyl cyanoacrylate (IBCA). It is believed that proximal arterial occlusion with balloons is an inferior choice for preresection embolization, because the technical difficulty of placement is high and the nidus of the AVM is unaffected. Vascular coagulation and section and AVM retraction are more difficult with IBCA; therefore, this is also considered an inferior choice. Among the materials studied, the combination of PVA for distal occlusion and microcoils for proximal occlusion appears to be the superior choice. Fewer complications (stroke or hemorrhage) are seen when intraarterial Amytal (amobarbital) testing is used to guide the embolization. Data regarding toxicity, oncogenicity, and vascular metabolism or recanalization associated with PVA, IBCA, and n-butyl cyanoacrylate are reviewed.",
keywords = "arteriovenous malformation, cerebrovascular system, cyanoacrylate, embolization, polyvinyl alcohol",
author = "Purdy, {P. D.} and Batjer, {H. H.} and Risser, {R. C.} and D. Samson",
year = "1992",
language = "English (US)",
volume = "77",
pages = "217--222",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "2",

}

TY - JOUR

T1 - Arteriovenous malformations of the brain

T2 - Choosing embolic materials to enhance safety and ease of excision

AU - Purdy, P. D.

AU - Batjer, H. H.

AU - Risser, R. C.

AU - Samson, D.

PY - 1992

Y1 - 1992

N2 - The authors report their experience with surgical resection of 108 previously embolized arteriovenous malformations (AVM's). Embolization was performed via only transfemoral catheterization in 70 lesions and via the surgical exposure of feeding vessels in 32. The remaining six patients were referred for resection following silicone sphere embolization elsewhere. Materials used included polyvinyl alcohol (PVA) foam, platinum microcoils, detachable silicone balloons, surgical silk, a mixture of 33% ethanol and microfibrillar collagen, and isobutyl cyanoacrylate (IBCA). It is believed that proximal arterial occlusion with balloons is an inferior choice for preresection embolization, because the technical difficulty of placement is high and the nidus of the AVM is unaffected. Vascular coagulation and section and AVM retraction are more difficult with IBCA; therefore, this is also considered an inferior choice. Among the materials studied, the combination of PVA for distal occlusion and microcoils for proximal occlusion appears to be the superior choice. Fewer complications (stroke or hemorrhage) are seen when intraarterial Amytal (amobarbital) testing is used to guide the embolization. Data regarding toxicity, oncogenicity, and vascular metabolism or recanalization associated with PVA, IBCA, and n-butyl cyanoacrylate are reviewed.

AB - The authors report their experience with surgical resection of 108 previously embolized arteriovenous malformations (AVM's). Embolization was performed via only transfemoral catheterization in 70 lesions and via the surgical exposure of feeding vessels in 32. The remaining six patients were referred for resection following silicone sphere embolization elsewhere. Materials used included polyvinyl alcohol (PVA) foam, platinum microcoils, detachable silicone balloons, surgical silk, a mixture of 33% ethanol and microfibrillar collagen, and isobutyl cyanoacrylate (IBCA). It is believed that proximal arterial occlusion with balloons is an inferior choice for preresection embolization, because the technical difficulty of placement is high and the nidus of the AVM is unaffected. Vascular coagulation and section and AVM retraction are more difficult with IBCA; therefore, this is also considered an inferior choice. Among the materials studied, the combination of PVA for distal occlusion and microcoils for proximal occlusion appears to be the superior choice. Fewer complications (stroke or hemorrhage) are seen when intraarterial Amytal (amobarbital) testing is used to guide the embolization. Data regarding toxicity, oncogenicity, and vascular metabolism or recanalization associated with PVA, IBCA, and n-butyl cyanoacrylate are reviewed.

KW - arteriovenous malformation

KW - cerebrovascular system

KW - cyanoacrylate

KW - embolization

KW - polyvinyl alcohol

UR - http://www.scopus.com/inward/record.url?scp=0026651170&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026651170&partnerID=8YFLogxK

M3 - Article

C2 - 1625008

AN - SCOPUS:0026651170

VL - 77

SP - 217

EP - 222

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 2

ER -