Embolization of pediatric brain arteriovenous malformations using n-butyl cyanoacrylate

Current treatment options available for brain arteriovenous malformations (BAVMs) include microsurgery, embolization and radiosurgery. At our hospital, we perform embolization with n-butyl cyanoacrylate (NBCA). When total obliteration of a BAVM is not achieved by embolization alone, gamma knife surgery (GKS) is used to eradicate the residual nidus. Because radiotoxicity is a serious problem, especially for pediatric patients, reduction of the radiation dose is essential. The objective of this paper is to clarify the role of NBCA embolization in the multimodal treatment of pediatric BAVMs based on our experience. Seven typical cases in patients under the age of 15 years were selected from among 145 individuals with BAVM who underwent embolization between 1997 and 2008 at our hospital. These cases were reviewed retrospectively. All the patients had undergone GKS after embolization of BAVMs, resulting in total obliteration or near total obliteration of the lesion. Although it is difficult to achieve a complete cure of BAVM with embolization alone, we believe that NBCA embolization contributes to the successful application of GKS by reducing the future marginal dose in pediatric patients. (author)