Cerebral Arterio- Venous Malformations: Effect of Partial Embolization on Cerebral Angioarchitecture

• Published in: Clinical neuroradiology (Munich) 2017-06, Vol.27 (2), p.260
• Main Authors: Spiessberger, A, Muroi, C, Marbacher, S, Gruter, B, Fandino, J, Diepers, M, Remonda, L
• Format: Article
• Language: English
• ISSN: 1869-1439
• DOI: 10.1007/s00062-017-0588-6

Aims: Endovascular occlusion of brain AVMs is an effective treatment modality, although it may result in partial nidus obliteration, thus requiring several treatment sessions and/or application of further treatment modalities. It has been observed that partial embolization may induce changes of the complex angioarchitecture of AVMs and the surrounding brain: recruitment of new feeding vessels, induction of perinidal angiogenesis and watershed transfer among others. In this study, we investigate the occurrence of such phenomena. Methods: At a single institution 64 AVMs were treated during a 7-year period. To study the effect of partial embolization on the angioarchitecture 19 patients were identified in whom cerebral angiograms prior to and after endovascular treatment were suitable to be analyzed for new feeder recruitment, induction of perinidal angiogenesis and watershed transfer. Results: The median follow-up period was 2.5 years (range 0.25-6.75 years). Adjuvant microsurgery was performed in 5 patients and radiosurgery in 6 patients. Analysis of DSA series suggested recruitment of new feeding arteries and the occurrence of perinidal angiogenesis in 5 cases (26%) each and the occurrence of watershed transfer in 2 cases (11%). Conclusion: Recruitment of new arterial feeders through watershed transfer and perinidal angiogenesis seems to develop after partial embolization in some cases. Such changes might influence the microsurgical strategy after embolization.