Embolization of arteriovenous malformations (AVMs) is a minimally invasive neurosurgical procedure aimed at occluding pathological vessels in the brain or spinal cord. AVMs are abnormal vascular connections that can lead to intracranial or spinal hemorrhage, seizures, and other neurological disorders. Embolization may be used as a standalone treatment or as a preparatory stage before microsurgical resection or radiosurgery.
Goals of embolization
- Reduction of hemorrhage risk. Decreasing blood flow through the AVM.
- Preoperative preparation. Reducing the size and vascularity of the AVM to facilitate surgical removal.
- Palliative treatment. Alleviation of symptoms such as headache or seizures caused by the AVM.
- Improvement of quality of life. Reduction of neurological symptoms associated with pathological shunting.
Indications for embolization
- Large AVMs. Complex vascular structures that cannot be safely removed by surgery alone.
- High risk of hemorrhage. AVMs with features associated with rupture, including associated aneurysms.
- Preparation for radiosurgery or open surgery. Reduction of blood supply to decrease procedural risks.
- Symptomatic AVMs. Seizures, chronic headaches, or focal neurological deficits.
Pre-procedural evaluation
- Diagnostic imaging. Magnetic resonance angiography (MRA), cerebral angiography, and computed tomography (CT).
- Multidisciplinary consultation. Neurologist, neurosurgeon, and interventional radiologist define the treatment strategy.
- Laboratory tests. Coagulation profile and biochemical blood analysis.
- Patient preparation. Discontinuation of anticoagulant therapy several days prior to the procedure.
Procedure steps
- Anesthesia. Performed under local or general anesthesia depending on lesion complexity.
- Vascular access. A catheter is introduced into the femoral artery through a small puncture.
- Catheter navigation. Under angiographic guidance, the catheter is advanced to the feeding vessels of the AVM.
- Delivery of embolic agents. Specialized materials are used, including liquid embolic agents, microcoils, and polymer compounds, to occlude abnormal blood flow.
- Final control. Post-embolization angiography is performed to assess the effectiveness of vessel occlusion.
Post-procedural period
- Monitoring. The patient is observed in hospital for 1–2 days.
- Recommendations. Avoid physical exertion for 1–2 weeks. Monitor for headache, weakness, or speech disturbances.
- Follow-up imaging. Control angiography or MRI is performed after 1–3 months.
Advantages of embolization of brain and spinal AVMs
- Minimally invasive approach. Small vascular access and rapid recovery.
- High effectiveness. Partial or complete exclusion of the AVM from the circulation.
- Reduction of surgical risks. Decreased intraoperative blood loss during subsequent interventions.
- Compatibility with combined treatment strategies. Embolization can be integrated with microsurgery or radiosurgery.
Timely diagnosis and a comprehensive treatment strategy for AVMs, including embolization, radiosurgery, and open microsurgical techniques, significantly increase the likelihood of a favorable outcome.
In Belarus, embolization of arteriovenous malformations is performed in leading neurosurgical centers using advanced equipment and modern endovascular technologies. Highly qualified specialists ensure a high level of safety and an individualized approach for each patient. Affordable medical costs make Belarus an attractive destination for the treatment of cerebrovascular disorders.
