Surgical excision of giant cerebellar hemispheric arteriovenous malformations following preoperative embolization

Abstract

The authors present two cases of giant cerebellar hemispheric arteriovenous malformation (AVM) managed with staged preoperative embolization and surgical resection. A new embolization technique is described, combining injection of estrogen alcohol and polyvinyl acetate into AVM's by superselective catheterization of feeding arteries. Polyvinyl acetate proved to be an ideal liquid embolic material; because it polymerizes quickly and remains in a gelatinous state after injection, there was no difficulty in cutting and retracting the obliterated AVM during surgery. Intraoperative digital subtraction angiography was useful for confirming complete excision of the large and complex AVM.