Curative Embolization of Cerebral AVMs - Glue is Still Relevant

Curative Embolization of Cerebral AVMs by Glue

We present three example cases of cerebral AVMs in different locations in which glue (NBCA) was the exclusive (2 cases) or main ( 1 case) embolic agent used. We were able to achieve complete obliteration of AVMs in all the 3 cases.

Case 1

Patient presentation

• Girl, 17-year-old. presented with acute onset headache f/b LOC in Dec, 2021
• CT/MRI-left posterior pericallosal bleed with IVH
• DSA → posterior pericallosal & choroidal AVM

Embolization Session -1 July 2022

• Pedicle-1: Left Pericallosal

• Pedicle-2: peri splenial br.

• Pedicle-3: Post. choroidal br.

• Pedicle-4: Post. choroidal br.

Embolization Session -2: March 2023

• Pedicle-1:Post choroidal-Microcatheter navigation

• Pedicle-2: Pericallosal

Final control angio

Case 2

Patient presentation

• A 9 yrs boy with sudden severe headache

Superselective navigation, glue injection & control angio

Post embo CT

Follow-up MRI @1mo

Case 3

Patient presentation

• A 32/M; h/o seizures since 2 years
• Headache f/b tonic posturing f/b LOC.
• No deficits

Embolization

• Pedicle-1: Onyx

• Pedicle-2: Glue

• Pedicle-3: Glue

Final Control Angiogram

• Non-adhesive liquid embolic agents have, no doubt, enabled us to achieve curative embolization in a wide range of cerebral AVMs.
• Yet NBCA (glue) still has its role as illustrated by our cases.
• Glue can be the primary agent in a certain group of AVMs- e.g choroidal