THE SAFETY AND EFFECTIVENESS OF BRAIN ARTERIOVENOUS MALFORMATION EMBOLIZATION USING ACRYLIC AND PARTICLES - THE EXPERIENCES OF A SINGLE INSTITUTION

THE PURPOSE OF this article is to report on the safety and effectivene ss of brain arteriovenous malformation (AVM) embolization for two seri es of patients, of which one was treated with particulate embolization and the other with acrylic embolization. Sixty-five consecutive patie nts from embolization logs and patient records from 1988 to 1993 were reviewed. AVMs were routinely treated with particulate embolization ea rly in the review (1988-1991), and after a transition period, the tech nique was changed to acrylic embolization for the remainder of the stu dy period (1992-1993). All patients were treated with the ultimate goa l of complete AVM obliteration. AVMs were embolized and resected, if p ossible, and if unresectable, they were reduced in size with embolizat ion and radiated. The course of treatment for each patient was reviewe d. The effectiveness at the end of treatment was analyzed for the abil ity to resect the AVM and, if unresectable, the ability to reduce the AVM to radiation size. Additionally, the safety of each embolization t echnique was evaluated in the context of comprehensive care, in terms of the safety of the procedure itself, the surgical resection after em bolization, and the outcome at the end of comprehensive treatment. Thi s article outlines the safety and effectiveness of acrylic and particu late embolization at a single institution. The ability to surgically r esect an AVM after embolization and to reduce nidus size with acrylic was at least comparable with that with particulate embolization. Compr ehensive complication rates were lower after acrylic embolization and were heavily influenced by a decreased number of surgical complication s in the acrylic series. These data support the need to conduct a rand omized prospective clinical trial to compare the relative safety and e ffectiveness of the two methods of embolization.