Document Detail


Targeting cerebral arteriovenous malformations for minimally invasive therapy.
MedLine Citation:
PMID:  17053601     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Cerebral arteriovenous malformation (AVM) embolization has been performed for nearly 40 years to reduce the risk of hemorrhage, to reduce symptomatic arteriovenous shunting, and to pretreat patients for surgical excision or radiosurgery. In some cases, embolization alone may be able to angiographically cure an AVM, although this is a small percentage of all AVMs. METHODS: This report reviews the current limitations of embolic therapy of cerebral AVMs from the standpoint of AVM angioarchitecture and the physical limitations of current embolic materials. In addition, it seeks to identify the areas in which embolization therapy may make advancements both as a pretreatment and as a sole therapy. RESULTS: Currently, liquid embolic agents, ethylene vinyl alcohol, and n-butylcyanoacrylate seem to provide the greatest resistance to recanalization in AVM embolization. These agents, however, elicit only a weak, nonspecific, bioactive inflammatory response by histopathology. CONCLUSION: The further evaluation and understanding of the vascular biology of AVM vessels and the endothelium cell wall biology will help us devise more bioactive material solutions to AVM nidus obliteration. Targeting specific receptors in AVMs with the embolic material delivered may additionally enhance the effects of radiosurgery in these patients.
Authors:
Michael J Alexander; Marshall E Tolbert
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Neurosurgery     Volume:  59     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-20     Completed Date:  2007-04-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S178-83; discussion S3-13     Citation Subset:  IM    
Affiliation:
Duke Neurovascular Center, Division of Neurosurgery, Duke Clinic, Durham, North Carolina 27710, USA. michael.alexander@duke.edu
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MeSH Terms
Descriptor/Qualifier:
Catheterization / methods*
Drug Delivery Systems / methods*
Embolization, Therapeutic / methods*
Humans
Intracranial Arteriovenous Malformations / diagnosis,  therapy*
Neurosurgical Procedures / trends*
Surgical Procedures, Minimally Invasive / methods*
Treatment Outcome
Vascular Surgical Procedures / trends*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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