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Endovascular treatment of head and neck arteriovenous malformations

  • Interventional Neuroradiology
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Abstract

Introduction

Head and neck arteriovenous malformations (H&N AVM) are associated with considerable clinical and psychosocial burden and present a significant treatment challenge. We evaluated the presentation, response to treatment, and outcome of patients with H&N AVMs treated by endovascular means at our institution.

Methods

Patients with H&N AVMs treated by endovascular means from 1984 to 2012 were evaluated retrospectively. These included AVMs involving the scalp, orbit, maxillofacial, and upper neck localizations. Patient’s clinical files, radiological images, catheter angiograms, and surgical reports were reviewed.

Results

Eighty-nine patients with H&N AVMs (46 females, 43 males; 48 small, 41 large) received endovascular therapy. The goals of treatment were curative (n = 30), palliative (n = 34), or presurgical (n = 25). The total number of endovascular treatment sessions was 244 (average of 1.5 per patient). The goal of treatment was met in 92.1 % of cases. Eventual cure was achieved in 42 patients accounting for 58.4 % (52/89) of all patients who underwent treatment for any goal. Twenty-eight of these patients were cured by embolization alone (28/89, 31.4 %) of which 18 were single-hole AVFs. Twenty-four were cured by planned surgical excision after presurgical embolization (24/89, 27 %). Seven patients (7/89, 7.2 %) suffered transient and two (2/89, 2.2 %) permanent endovascular treatment complications.

Conclusion

Endovascular treatment is effective for H&N AVMs and relatively safe. It is particularly effective for symptom palliation and presurgical aid. Embolization is curative mostly in small lesions and single-hole fistulas. In patients with large non-curable H&N AVMs, endovascular therapy is often the only palliative option.

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Acknowledgments

We would like to thank Dr. O. Antonyshyn of the Sunnybrook Health Sciences Centre and Drs. Pat Gullane and Ralph Gilbert of the University Health Network for their invaluable assistance in the surgical management of our mutual patients.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada

    A. A. Dmytriw

  2. Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario, M5T 2S8, Canada

    K. G. ter Brugge, T. Krings & R. Agid

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  1. A. A. Dmytriw
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  2. K. G. ter Brugge
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  3. T. Krings
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  4. R. Agid
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Correspondence to R. Agid.

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Dmytriw, A.A., ter Brugge, K.G., Krings, T. et al. Endovascular treatment of head and neck arteriovenous malformations. Neuroradiology 56, 227–236 (2014). https://doi.org/10.1007/s00234-014-1328-0

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  • DOI: https://doi.org/10.1007/s00234-014-1328-0

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