Superselective Catheterization and Embolization of Cerebral Arteriovenous Malformations

Abstract

Endovascular embolization of AVMs has progressively been more accepted for the management of lesions that are decided unresectable either because of their size or location. Since the introduction of endovascular treatment for brain AVMs by Leus- senhop (Leussenhop and Spence 1960) and for carotid cavernous fistulas by Serbinenko (1974), a variety of catheter assembly systems and embolic materials have widened our possibilities. It is now possible to catheterize very selectively the feeding arteries, which then permits delivery of embolic material into the nidus of the malformation. To decide what treatment is best, in an individual situation, patients are evaluated in a team approach. The neuroradiologists, neurosurgeons, and neurologists, and the patient himself participate in the decision process, let it be surgical resection, embolization, or a combination of both; or in some instances, only conservative management may be best. Certain small size malformations can be successfully treated by radiation therapy (Steiner 1984). This communication will deal exclusively with the embolization part of the treatment.