Prognostic factors for seizure control after endovascular embolization of brain arteriovenous malformations

INTRODUCTION. Arteriovenous malformations of Spetzler – Martin grades III–V are characterized by complex angioarchitecture, deep localization, and a higher incidence of epileptic syndrome compared to grade I–II AVMs. These features complicate both the technical execution of the intervention and the objective assessment of its impact on seizure control. In the present study, special attention is given to the analysis of seizure dynamics following endovascular treatment in patients with high-grade AVMs in order to clarify its effectiveness in this clinical cohort. AIM. To identify prognostic factors for epileptic seizure control following embolization of arteriovenous malformations (AVMs), with a focus on the degree of vascular occlusion and its correlation with clinico-radiological parameters. MATERIALS AND METHODS. A retrospective study included 60 patients divided into two groups: group 1 (n=30) underwent total/subtotal embolization (>95 % occlusion), and group 2 (n=30) underwent partial embolization (<95 %). Efficacy was assessed using the Engel scale with a minimum follow-up period of 12 months. Statistical analysis utilized the 2 test, Fisher’s exact test, Mann – Whitney U test, and odds ratio (OR) calculation. RESULTS. In the total embolization group, complete seizure cessation (Engel Ia) was achieved in 56,7 % of patients compared to 23,3 % in the partial embolization group. The rate of unfavorable outcomes (Engel IVb+IVc) was 16,6 and 36,7 %, respectively. Complications were reported only in the total embolization group. In patients with partial embolization, a baseline low seizure frequency (<1/year) was a significant predictor of success (p=0,0008; OR=55,0). CONCLUSION. Total embolization of AVMs provides a higher rate of complete epilepsy control but is associated with   procedural risks. Partial embolization demonstrates satisfactory outcomes in patients with rare seizures, suggesting its potential as a first-line therapeutic strategy for carefully selected cases.

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