Craniofacial arteriovenous malformation:: Preoperative embolization with direct puncture and injection of n-butyl cyanoacrylate

PURPOSE: To evaluate the use of n-butyl cyanoacrylate (NBCA) for preoperative embolization of craniofacial arteriovenous malformation. MATERIALS AND METHODS: Fourteen patients with craniofacial arteriovenous malformation (forehead [n = 9], deep facial [n = 3], occipital [n = 1] or lip [n = 1] lesion) were treated with injection Of NBCA. Forehead lesions were supplied by ophthalmic (n = 6) and/or superficial temporal arteries (n = 7); and facial and scalp lesions, by lesions, by bilateral internal maxillary (n = 4), facial (n = 2) and/or occipital-arteries (n = 1). Lesions were percutaneously punctured with a 20-gauge needle in the area of arteriovenous connection. Direct angiography was performed before and after compression of venous drainage, and NBCA diluted 30%-50% with iodized oil was injected during venous compression. RESULTS: Postembolization arteriograms showed that six lesions were completely devascularized after single or multiple (one to nine) injections, and five were effectively devascularized (greater than or equal to 90%). Although three lesions were 60%-70% devascularized after injection, two of these were successfully extirpated with no notable blood loss. In nine patients, the ophthalmic arterial supply had disappeared after embolization. There were no procedure-related complications. CONCLUSION: Direct-puncture embolization with NBCA is an effective a nd safe technique for preoperative devascularization of craniofacial arteriovenous malformation. For safe and effective devascularization channels is thought to be important.