Endovascular treatment of small cerebral arteriovenous malformations as a primary therapy

Purpose
The patient population that would benefit most from endovascular curative treatment of intracranial arteriovenous malformations has not been clearly established. The aim of the study was to determine the effect of curative embolisation of cerebral arteriovenous malformations with special regard to radiographic and clinical outcomes and procedure-related complications

Material and methods
Between January 2009 and December 2014, 18 patients with intracranial arteriovenous malformations were embolised with Onyx with intent to cure. There were four women and 14 men, with a mean age of 40 years (range 10-62 years). Inclusion criteria were: maximal diameter of the lesions ≤ 3 cm and arterial supply consisting of no more than two major arteries. Five (27.8%) patients had ruptured lesions, and 13 (72.2%) patients had unruptured lesions. Mean arteriovenous malformation size was 2.3 cm (range 1.5-2.9 cm).

Results
Thirty-three procedures were performed in 18 patients. Total obliteration was achieved in five patients (27.8%). The most common reason for initial incomplete angiographic occlusion was unfavourable angioarchitectural features of arteriovenous malformations, with the rate of 44.4%. The mean follow-up of patients with complete occlusion was 35.2 months (range 18-60 months). Complication rate was 12.1%. One patient had permanent neurological deficit with resulting morbidity of 5.6%. There were no deaths.

Conclusions
Embolisation of intracranial arteriovenous malformations plays a limited role as a sole therapeutic modality even in terms of small lesions with two or fewer arterial feeders, although larger prospective series are necessary to confirm these findings. Associated complications are not trivial and should be considered when choosing this form of treatment.