Endovascular treatment of cerebral arteriovenous malformations and Dural arteriovenous malformations

Objective: To report our experience with the endovascular management of cerebral arteriovenous malformations and dural arteriovenous fistulas. Methods: Fifty patients (66% males and 34% females) with cerebral arteriovenous malformations and dural arteriovenous fistulas were treated in our department between September 2007 and April of 2010 using endovascular therapy. A total of 84 endovascular procedures were performed. N-butyl cyanoacrylate Histoacryl was the embolic material used in 76% of the cases; Onyx alone was used in 20%, Onyx and coils combined in 3.6%. Results: The most common symptoms were headache, epileptic seizures and intracranial hemorrhage. Thirty-two percent of the patients were cured using embolization as the only therapeutic technique, meaning that a higher number of patients were cured in just one session. Thirty-eight percent of all patients underwent a surgical resection or radiosurgical treatment after nodal size reduction through endovascular treatment. The overall reported complications were 5.9%. Conclusion: Cerebral arteriovenous malformations and dural arteriovenous fistulas are complex lesions with a potential risk for intracranial hemorrhages. Endovascular therapy is safe and effective, and together with surgery and radiosurgery, is an essential component of the multimodal approach to this problem.