Neurological Deficit From an Inoperable Arteriovenous Malformation

The phenomenon of hemodynamic "steal" has been used to explain progressive neurological deficits in patients with large cerebral arteriovenous malformations (AVMs).1-7According to this theory, the sump effect of an AVM competes with the surrounding brain for blood flow, causing relative ischemia that can slowly increase over time. Progressive neurological deficit associated with inoperable AVMs has been considered to be an indication for flow-directed sphere embolization.3,8,9 The development of techniques for safe, direct, superselective catheterization, both by femoral placement of calibrated-leak balloon catheters10-13and by direct surgical catheterization at craniotomy,10,13-15has allowed for the embolic injection of isobutyl-2-cyanoacrylate (IBC), a fast-polymerizing tissue adhesive, into AVMs. The embolization techniques using this approach have evolved to include therapy of large, strategically placed AVMs with multiple feeders.15Our series of patients treated with IBC includes three who showed remarkable functional recovery of paralyzed limbs during or following IBC