Endovascular transvenous treatment for superficial intracranial arteriovenous malformations

Objective: The objective of this study was to evaluate the feasibility and outcomes of transvenous endovascular embolization (TVE) for superficial intracranial arteriovenous malformations (AVMs). Methods: After collecting clinical and imaging data, a prospective series of 11 patients presenting with superficial AVMs were treated by endovascular embolization using a transvenous approach between November 2016 and October 2018. Results: Ten patients (90.9%) had ruptured AVMs before TVE. The mean nidus size was 3.27 ± 1.47 cm, and the median Spetzler-Martin grade was II. The rate of immediate angiographic occlusion of the AVMs was 90.9% (10/11). One patient was treated with transarterial embolization since TVE was not achieved due to an unsuccessful positioning of the microcatheter. Two patients (cases 8 and 11) suffered a intracranial hemorrhage and a cerebral infarction with encephaledema, respectively, but no procedure-related mortalities were observed. Eight patients (72.7%) were independent with a modified Rankin Score (mRS) ≤ 2 at discharge and the mRSs of all patients, which were collected 30 days postintervention, were not more than 2. The mean follow-up period was 17 months. There were no nidus recurrences during the follow-up period. Conclusions: The curative transvenous embolization of superficial AVMs seems feasible and effective while carefully monitoring for embolization-related complications.