Preoperative embolization of cerebral arteriovenous malformations with silk sutures: analysis and clinical correlation of complications revealed on computerized tomography scanning

Object. The aim of this study was to determine the incidence and clinical s ignificance of complications related to preoperative embolization of cerebr al arteriovenous malformations (AVMs) with silk sutures as documented on po stprocedure computerized tomography (CT) scans. Methods. The CT scans were obtained within 12 to 24 hours after 221 (96%) o f 230 consecutive embolizations in 70 patients. These CT scans were evaluat ed for the presence of ischemia, infarction, hemorrhage, or contrast agent extravasation. Adverse patient outcomes were determined after each emboliza tion and were correlated with CT findings. New abnormalities demonstrated o n CT scans were also correlated with the Spetzler-Martin AVM grade, degree of arteriovenous shunting, and location. New abnormalities, the majority of them infarcts, resulted from 29 (13%) of 221 embolization procedures. In 1 1 (38%) of 29 cases of new CT findings, patients were asymptomatic, includi ng 10 with new infarcts on CT scans. New neurological deficits occurred in 20 (8.7%) of 230 total embolization procedures in 19 patients, including on e death. Permanent deficits occurred in nine patients (3.9% per embolizatio n procedure, 12.8% per patient). Of the patients with new neurological defi cits, 18 (90%) of 20 embolization procedures resulted in new abnormalities on CT scans. Two patients with new transient neurological deficits had no n ew findings on CT scans. Spetzler-Martin grade, AVM location, degree of art eriovenous shunting, and higher numbers of procedures were not statisticall y associated with a higher incidence of abnormalities on CT scans or new pe rmanent neurological deficits. Conclusions. Silk sutures are an effective and relatively safe embolic agen t. After brain AVM embolization with silk sutures, new abnormalities were f ound on CT scans obtained in one of eight procedures. When a new CT finding occurred, the patient had roughly equal chances of having no new symptoms, having new transient neurological deficits, or having new permanent neurol ogical deficits.