N-butyl cyanoacrylate transvenous arteriovenous malformation embolization with arterial balloon assistance: Defining parameters for a transvenous approach as a potential upfront treatment option in managing cerebral arteriovenous malformations

Catherine Higbie; Deepak Khatri; Barbara Ligas; Rafael Ortiz; David Langer

doi:10.4103/ajns.AJNS_357_19

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 434-439
DOI: 10.4103/ajns.AJNS_357_19

Case Report

N-butyl cyanoacrylate transvenous arteriovenous malformation embolization with arterial balloon assistance: Defining parameters for a transvenous approach as a potential upfront treatment option in managing cerebral arteriovenous malformations

Authors

Catherine Higbie

Department of Neurosurgery, Lenox Hill Hospital, New York City, New York
Deepak Khatri

Department of Neurosurgery, Lenox Hill Hospital, New York City, New York
Barbara Ligas

Department of Neurosurgery, Lenox Hill Hospital, New York City, New York
Rafael Ortiz

Department of Neurosurgery, Lenox Hill Hospital, New York City, New York
David Langer

Department of Neurosurgery, Lenox Hill Hospital, New York City, New York

Abstract

Complete obliteration of arteriovenous malformations (AVMs) using a transvenous approach as the primary and stand-alone treatment modality has been increasingly considered as a useful endovascular approach in the treatment of AVMs. AVMs are typically treated with microsurgery, stereotactic radiosurgery, endovascular embolization, or some combination of the three methods. Preservation of the draining vein is a key requisite common to all treatment modalities. Transvenous embolization (TVE) is conventionally not recommended as a stand-alone treatment for the vast majority of AVMs and has been thought to be best indicated when traditional approaches are considered less safe and when specific evaluation criteria are met. We report a case of a 35-year-old asymptomatic male diagnosed with a small intracranial AVM adjacent to the right motor strip which was managed utilizing this approach. We employed endovascular embolization via a transvenous approach with arterial balloon assistance due to the small size of the nidus, eloquent location, en passage arterial supply proximal to the venous varix, and a single draining vein from the fistula. This case illustrates the selective indications and technical nuances of TVE approach in managing AVMs as a potential upfront treatment option. When patients harbor AVMs with specific angio-architectural findings as outlined, TVE utilizing Onyx or N-butyl cyanoacrylate can be safely performed as a primary treatment modality.

Key-words:

Arteriovenous malformation - balloon assistance - transvenous embolization

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References

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