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Endovascular Treatment of Arteriovenous Malformations of the Brain

  • Alex Berenstein
  • Pierre Lasjaunias
  • In Sup Choi
Part of the Medical Radiology book series (MEDRAD)

Abstract

The endovascular approach to arteriovenous malformations dates back to the original work by Luessenhop in the 1960s. Luessenhop employed free-floated particulate material introduced into the internal carotid artery after surgical exposure of the carotid artery. The original material was steel particles covered with methyl methacrylate. This approach was then refined by using barium-impregnated Silastic spheres. The technique was inspired by the original work of Brooks, who injected muscle particles into the internal carotid artery in an attempt to occlude carotid cavernous fistulas. The rationale of silicone sphere embolization was to obliterate the feeding pedicles to large, surgically inaccessible malformations. Subsequently the percutaneous transcatheter technique was developed by Kricheff in the early 1970s; this permitting greater flexibility, enabling either the anterior or the posterior circulation to be approached. The major drawback of such an approach was the size of the embolic particles that could be injected. This nonselective technique was employed as a palliative measure in large malformations, or for presurgical embolization, or as part of a staged procedure (Hilal and Michelsen 1975; Wolpert et al. 1981). The more modern era of endovascular embolization was pioneered by Kerber (1976), assisted by the possibility of employing flow-guided microballoon catheters with a calibrated leak microballoon system. This catheter assembly system consisted of very flexible and soft Silastic tubing to which a Silastic balloon with a calibrated “leak” was attached. Modifications of this technique included the use of a pressure chamber (Pevsner 1977) and the use of calibrated leak latex balloons (Berenstein 1981; Debrun et al. 1982). The latest generation of variable stiffness microcatheters has revolutionized the approach to cerebrovascular navigation in the endovascular treatment of arteriovenous malformations of the brain (BAVMs).

Keywords

Digital Subtraction Angiography Endovascular Treatment Arteriovenous Malformation Embolic Agent Venous Malformation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • Alex Berenstein
    • 1
  • Pierre Lasjaunias
    • 2
  • In Sup Choi
    • 3
  1. 1.Department of RadiologyNew York University Medical CenterNew YorkUSA
  2. 2.Unité de Neuroradiologie Vasculaire Diagnostique et Thérapeutique, Hôpital BicêtreUniversité Paris SudKremlin-BicêtreFrance
  3. 3.RadiologyMassachusetts General HospitalBostonUSA

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