OBJECTIVE: To demonstrate that nidus embolization of brain arterioveno
us malformations (AVMs) with Histoacryl (B. Braun, Melsungen, Germany)
is effective and yields low morbidity and mortality rates. METHODS: W
e present a retrospective analysis of 54 brain AVMs treated at the Uni
versity of Illinois at Chicago from April 1994 to December 1995. Treat
ment modalities included embolization in all cases and then surgical r
esection or radiosurgery. INSTRUMENTATION: The nidus was reached with
the combined use of a Magic microcatheter (Bait, Montmorency, France)
and a Terumo 0.010-inch guidewire. TECHNIQUE: Embolization was perform
ed only when the tip of the microcatheter was wedged into the nidus of
the AVMs with no reflux of contrast proximally. The embolization was
performed using simultaneous biplane roadmapping with the patient unde
r general anesthesia without Amytal testing. RESULTS: Twenty-six of 54
patients are still waiting for more radical treatment. Two deaths and
two minor and one severe permanent neurological deficit occurred. Thr
ee patients were cured with embolization alone; 11 patients were cured
after surgical resection. Three patients underwent radiosurgery, with
one cure after 1 year. CONCLUSION: Nidus embolization with Histoacryl
is an effective technique that permits complete cure of a large numbe
r of brain AVMs, with or without surgical resection and/or radiosurger
y.