Abstract
Twenty patients underwent endovascular treatment for cerebral arteriovenous malformation (AVM). In the initial ten patients, preoperative occlusion of feeding arteries was performed using detachable balloon catheter. In the next ten patients, embolizations of nidus of the AVM were performed using liquid ethylene vinyl alcohol co-polymer or polyvinyl alcohol particles through Tracker-18 catheter or leak balloon catheter. We compared the effects and problems between preoperative balloon occlusion of feeding arteries and embolization of nidus.
Both balloon occlusion and embolization were performed after provocative test. There was no complication associated with balloon occlusion, but there were five minor neurological deficits among twenty-one procedures of embolization. Though the balloon occlusions were efficient, some of them were not so effective because of the incomplete flow reduction of balloon occlusion. In one case the AVM disappeared completely only by embolization. In another case, after embolization, the AVM was treated by bragg-peak proton-beam therapy, a form of stereotactic radiosurgery.
In conclusion, preoperative balloon occlusion is relatively safe and this method is effective in some cases. However, it is incomplete in some other cases. On the other hand, embolization is more effective for the treatment of the AVM, and this method might be used as not only preoperative treatment but also final treatment in combination with stereotactic radiosurgery. And it should be performed very carefully in order not to cause any complications.
