Endovascular Treatment for Intracranial Arteriovenous Malformations
Endovascular Treatment for Intracranial Arteriovenous Malformations
Endovascular therapy for arteriovenous malformations (AVMs) remains a relatively new approach. Beginning in the 1960s with the use of flow-directed techniques for selective embolization, hemodynamic alterations have been used to treat these lesions. In every aspect of treatment, technological advances, including catheters, embolic materials, angiography suites, and pharmacological agents, have improved outcomes while lowering the risk to patients.
In this article, the authors review the technical evolution of endovascular AVM therapy. Developments in embolic materials, beginning with foreign bodies and autografts and continuing through to highly engineered contemporary substances, are discussed. Finally, changes in treatment paradigms that have occurred over the years are traced. Within neurosurgery, this specialty has shown some of the fastest growth and development in recent decades. As minimally invasive approaches are embraced in all areas of medicine, it is clear that this treatment modality will continue to be refined.
It is difficult to say precisely when endovascular neurosurgery began. As Dr. Charles Kerber eloquently describes in "Personal Accounts of the Evolution" (Kerber C, personal communication, 2006), surgeons at the turn of the twentieth century were aware of the potential therapeutic utility of intracranial blood flow. Major, mainstream developments in endovascular treatment for intracranial AVMs began in the early 1960s. Although a muscle plug embolus was intentionally introduced through the ICA in 1930, it was many years before endo vascular treatment for any intracranial pathological condition gained popularity. Luessenhop and Spence first re port ed the concept of using enlarged, abnormal feeding arteries for direct embolization. This method was initially de scribed as "artificial embolization," and they planned to use the smaller nidus vessels to block penetration of embolic material and therefore occlude proximal feeding vessels. This concept is still integral to today's technology. Much of the pioneering work on embolic agents focused on the occlusion of aneurysms. Electrothrombosis as well as balloon and coil occlusion were all first used to treat saccular aneurysms, but these techniques have also contributed to AVM treatment. In this article, we review spe cific catheter and embolic techniques and the way in which concurrent advances in fluoroscopic techniques and angio graphic suites have contributed to the evolution of this specialty.
Endovascular therapy for arteriovenous malformations (AVMs) remains a relatively new approach. Beginning in the 1960s with the use of flow-directed techniques for selective embolization, hemodynamic alterations have been used to treat these lesions. In every aspect of treatment, technological advances, including catheters, embolic materials, angiography suites, and pharmacological agents, have improved outcomes while lowering the risk to patients.
In this article, the authors review the technical evolution of endovascular AVM therapy. Developments in embolic materials, beginning with foreign bodies and autografts and continuing through to highly engineered contemporary substances, are discussed. Finally, changes in treatment paradigms that have occurred over the years are traced. Within neurosurgery, this specialty has shown some of the fastest growth and development in recent decades. As minimally invasive approaches are embraced in all areas of medicine, it is clear that this treatment modality will continue to be refined.
It is difficult to say precisely when endovascular neurosurgery began. As Dr. Charles Kerber eloquently describes in "Personal Accounts of the Evolution" (Kerber C, personal communication, 2006), surgeons at the turn of the twentieth century were aware of the potential therapeutic utility of intracranial blood flow. Major, mainstream developments in endovascular treatment for intracranial AVMs began in the early 1960s. Although a muscle plug embolus was intentionally introduced through the ICA in 1930, it was many years before endo vascular treatment for any intracranial pathological condition gained popularity. Luessenhop and Spence first re port ed the concept of using enlarged, abnormal feeding arteries for direct embolization. This method was initially de scribed as "artificial embolization," and they planned to use the smaller nidus vessels to block penetration of embolic material and therefore occlude proximal feeding vessels. This concept is still integral to today's technology. Much of the pioneering work on embolic agents focused on the occlusion of aneurysms. Electrothrombosis as well as balloon and coil occlusion were all first used to treat saccular aneurysms, but these techniques have also contributed to AVM treatment. In this article, we review spe cific catheter and embolic techniques and the way in which concurrent advances in fluoroscopic techniques and angio graphic suites have contributed to the evolution of this specialty.