Results of total transvenous embolisation of supratentorial cerebral arteriovenous malformations
https://doi.org/10.56618/2071-2693_2024_16_3_83
EDN: ILVHWT
Abstract
INTRODUCTION. The efficacy and safety of transvenous embolisation in the treatment of cerebral arteriovenous malformations (AVMs) remain poorly understood, given the very limited number of reported cases. This prospective study was conducted to evaluate this technique in the treatment of cerebral AVMs.
MATERIALS AND METHODS. From January 2018 to December 2023, 53 patients with cerebral AVMs who underwent transvenous or transvenous-transarterial (combined) total embolisation were examined at the Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre. AVMs were divided according to the Spetzler – Martin classification: gradation I was in 3 (5.7 %) AVMs , II in 13 (24.5 %), III in 26 ( 49.1 %), IV in 8 (15.1 %), and V in 3 (5.7 %). The mean age of the patients was 37.94±11.13 (range 19-66). The sex ratio M:W was 49.1:50.9%. The mean embolisation stage was 2 (range 1–13). The incidence of complete AVM occlusion was calculated based on DSA images obtained immediately postoperatively and 6–12 months after surgery. The occurrence of haemorrhages and infarcts after embolisation was assessed by CT and MRI immediately after surgery and at 1 month after total embolisation. The mRS scale was used to assess functional outcomes.
RESULTS. Complete AVM obliteration was noted in 46 (86.8 %) of 53 patients after embolisation, in 5 (9.4 %) patients total AVM obliteration was achieved with a combination of endovascular and microsurgical treatment. Of 53 patients 2 (3.8 %) died. Postoperative intracranial haemorrhages were detected in 10 (18.9 %). Functional outcomes were assessed: the proportion of patients with mRS ≤2 decreased from 94.2 % (49/53), before embolisation to 82.9 % (44/53) after embolisation, mRS 3–4 =5.7 % (3/53) before embolisation, after 11.3 % (6/53); mRS 5 = 1.9 % (1/53). The mRS scores at the time of follow-up angiography mRS ≤2 90.1 % (46/51), mRS 3–5 =9.9 % (6/51). The percentage of good results (mRS ≤2) in the remote period increased by 7.2 % from 82.9 % (44/53) to 90.1 % (46/51), the percentage of poor results decreased by 3.3 % mRS 3–5 from 13.2 % to 9.9 %.
CONCLUSION. Transvenous embolisation can be performed as an independent technique for total occlusion of cerebral AVMs with a high rate of complete obliteration, improved functional outcomes and acceptable morbidity and mortality, but it should be considered mainly as the method of choice when performing the final stage of multistage embolisation.
About the Authors
A. N. Nazarbekov
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre
Russian Federation
Russian Federation
Azamat N. Nazarbekov – Postgraduate Student at the Department of Neurosurgery
12 Mayakovskogo street, St. Petersburg, 191025
A. E. Petrov
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre
Russian Federation
Russian Federation
Andrey E. Petrov – Cand. of Sci. (Med.), Neurosurgeon, Head at the Neurosurgical Department No. 3
12 Mayakovskogo street, St. Petersburg, 191025
A. Yu. Ulitin
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre
Russian Federation
Russian Federation
Alexey Yu. Ulitin – Dr. of Sci. (Med.), Full Professor, Honored Doctor of Russian Federation, Neurosurgeon of the Highest Qualification Category, Head at the Department of Neurosurgery No 4; Professor at the Department of Neurosurgery named after prof. A. L. Polenov
12 Mayakovskogo street, St. Petersburg, 191025
A. A. Ivanov
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre
Russian Federation
Russian Federation
Arkady A. Ivanov – Cand. of Sci. (Med.), Senior Researcher, Research Institute of Vascular Surgery of the Brain and Spinal Cord
12 Mayakovskogo street, St. Petersburg, 191025
S. H. Sotlanov
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre
Russian Federation
Russian Federation
Soltan H. Sotlanov – Resident at the Department of Neurosurgery
12 Mayakovskogo street, St. Petersburg, 191025
L. V. Rozhchenko
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre
Russian Federation
Russian Federation
Larisa V. Rozhchenko – Cand. of Sci. (Med.), Head at the Research Institute of Vascular Surgery of the Brain and Spinal Cord
12 Mayakovskogo street, St. Petersburg, 191025
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For citations:
Nazarbekov A.N., Petrov A.E., Ulitin A.Yu., Ivanov A.A., Sotlanov S.H., Rozhchenko L.V. Results of total transvenous embolisation of supratentorial cerebral arteriovenous malformations. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2024;16(3):83-94. (In Russ.) https://doi.org/10.56618/2071-2693_2024_16_3_83. EDN: ILVHWT
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