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Pre-Surgical Endovascular Proximal Feeder Artery Devascularization Technique for the Treatment of Cranial Arteriovenous Malformations

Authors Alawneh K, Abuzayed B, Al Qawasmeh M, Raffee L, Aleshawi A

Received 2 January 2020

Accepted for publication 6 May 2020

Published 19 May 2020 Volume 2020:16 Pages 181—191

DOI https://doi.org/10.2147/VHRM.S244514

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Daniel A. Duprez


Khaled Alawneh,1 Bashar Abuzayed,2 Majdi Al Qawasmeh,3 Liqaa Raffee,4 Abdelwahab Aleshawi5

1Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 2Department of Neurosurgery, The Specialty Hospital, Amman, Jordan; 3Department of Neuroscience, Division of Neurology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 4Department of Accident and Emergency, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 5King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan

Correspondence: Khaled Alawneh
Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
Tel +962795314555
Email kzalawneh0@just.edu.jo

Objective: Treatment of brain arteriovenous malformations (AVMs) aims to abolish any risk for intracranial hemorrhage with the preservation of the patient’s functional status. We present the technique of pre-surgical endovascular devascularization through proximal feeder artery occlusion for the treatment of cranial AVMs rather than nidus occlusion. Also, we highlight the advantages and the possible clinical indications.
Patients and Methods: Two patients with brain AVM and one patient with scalp AVM were treated by pre-surgical endovascular devascularization followed by surgical resection. Endovascular devascularization was performed by occlusion of the AVM feeders only with Liquid Embolic System Agent (Onyx®) 18 without entering and filling the nidus. During surgery, feeding arteries colored with the black color of the Liquid Embolic System Agent were clearly identified and cut. Dissection of the AVM was performed, and resection of the nidus was achieved.
Results: Total resection of the AVM was achieved in all cases confirmed with follow-up angiographies, with no neurologic or systemic complications. Also, no major bleeding was detected. In addition, the surgical clips were avoided during surgery. Brain AVMs were safely resected in piecemeal fashion.
Conclusion: Pre-surgical endovascular proximal feeder artery devascularization technique shows to be a safe, simple and effective technique for the management of cranial arteriovenous malformations. This technique simplifies both the endovascular and surgical approaches to complicated cranial AVM cases.

Keywords: angiography, arteriovenous malformation, devascularization, endovascular, surgical resection

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