Endovascular complications of brain arteriovenous malformations: Considerations and hemodynamic analysis

Introduction: The aim of this section was to review the current status of the data and concept of endovascular complications and discuss their management on the basis of cerebral blood flow (CBF) dynamics and perioperative monitoring for interventions. Methods: We searched the literature in PubMed data base, using the following key words: incidence, natural history, prevention of rebleeding, endovascular treatment, CBF, complications, and intraoperative monitoring. We also present our data on complications here briefly, 107 cases of 181 procedures for AVMs underwent between April 2007 and July 2017. Fourty non-consecutive patients, perioperative monitoring using CT perfusion (CTP) and regional cerebral oxygen saturation with near infrared spectroscopy were measured. Results: Endovascular complications were categorized according to the angioarchitecture analysis for therapeutic planning; CBF assessment and monitoring, especially of the perinidal brain tissue; and postinterventional intensive care unit management. A hemorrhagic complication occurred in 13 (7.1%) procedures, morbidity 5 patients (4.6%), one patient mortality (0.9%). Ischemic complications occurred 26 procedures (14.4%), morbidity 3 patients (2.8%). There were no significant changes in CTP parameters, however in some patients both CTP and rSO2 monitoring provided useful information. Conclusion: Evaluating the outcomes before and after interventions for cerebral hemodynamics is difficult. However, computed tomography perfusion, perfusion-weighted imaging, and continuous regional cerebral oxygen saturation measurement can be used for the early detection of postoperative cerebral hemorrhage. This section describes the current knowledge on arteriovenous malformation embolization complications and management as well as future studies.