Abstract
Successful embolization can be achieved only when the follwing three factors are correct and in cooperation : catheter tip position, flow control, ant the setting time of normal-butyl cyanoacylate (NBCA) . Otherwise, the procedure may end with unsatisfactory results or complications. The current principle of safe and efficient embolization of cerebral arteriovenous malformation (AVM) is based on superselective cannulation of every strategically important feeding pedicle and injection of liquid embolic material under flow control. This study was based upon our experiences of embolizing 96 cases with cerebral AVM performed under the above conditions at our department. Results shows very encouraging new observations with implications for further procedures : total removal of the AVM nidus after embolization was achieved in 90% of the cases, preradio-surgical embolization achieved 52% volume reduction and successfully maneuvered all cases into the gamma knife focal spot. Recently improved microcatheters with increased flexibility and minimal friction made it possible to place the tip of the microcatheter into the nidus with a higher success rate and better safety factors. In order to obliterate a substantial amount of the AVM nidus and prevent penetration into the draining veins, the creation of optimal flow status, and optimal setting time of NBCA have paramount importance. Forthcoming complete microcatheter/guidewire units and new embolic materials will enable us to perform safer and more efficient embolization even though the AVM is located distally or fed by perforating arteries.
