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Technique of Fractionated Transcatheter Arterial Embolization for Treating Large Arteriovenous Malformation in Brain Functional Area

Objective: At present, large cranial function area arteriovenous malformation (fAVM) is mainly treated by craniotomy with a high risk of operation and high disability. In recent years, with the continuous improvement of the neural intervention technology, fractionated transcatheter arterial embolization (fTAE) may be used to treat the fAVM instead of surgical treatment. However, its effectiveness for treating fAVM has never been explored. The authors hypothesized that fTAE can be effective in the treatment of fTAE. Methods: A retrospective study was conducted in 229 cases of large fAVM in multicenter hospitals. Among them, 103 cases were performed fTAE and the other 126 cases were carried on minimally invasive craniotomy (MIC). Clinically relevant symptomatic improvement and complications were compared between 2 groups. Results: Complete resection rate of arteriovenous malformation in MIC group (100%) was significantly higher than that of complete embolization rate in fTAE group (77.7%) (P = 0.000). However, the incidence of postoperative complications includes decreased limb muscle strength (P = 0.001), sensory loss of extremities (P = 0.003), visual field defect (P = 0.025) that were lower in fTAE group and remission rate of headache (P = 0.012) but not epilepsy (P = 0.952) was higher in fTAE group compared with that in MIC group. After 1 year follow-up, the rebleeding rate in the fTAE treatment group was 4.85%, higher than that in MIC group (0%) (P = 0.000). Conclusions: Fractionated transcatheter arterial embolization therapy is beneficial for reducing the postoperative complications and preoperative symptoms of fAVM, but not for recurrence rate.