Partial transvenous embolization as an intermediate strategy for large brain arteriovenous malformations: A technical note

Background Endovascular transvenous embolization (TVE) was developed as a curative technique for brain arteriovenous malformations (bAVMs) with small nidi and a single draining vein. We describe a partial transvenous embolization technique (pTVE) as an intermediate embolization session to decrease hemorrhagic complications of larger nidi with multiple venous outlets. Method We reviewed our single-center database of bAVMs treated endovascularly between January 2023 and March 2024. Six consecutive patients underwent 10 sessions of pTVE for ruptured AVMs. Results The median age of patients was 24.5 years. The median nidus size was 5 cm (range 4–6 cm). Three patients had grade III lesions according to the Spetzler-Martin classification, two were grade IV, and one was grade V. Four patients had draining veins with multiple efferent veins with each collecting vein, one patient had multiple efferent veins with one collecting vein, and one patient had one efferent vein with a long bifurcation. pTVE achieved partial occlusion in all cases without any hemorrhagic complications. One patient had the AVM totally occluded with two sessions of pTVE. Decision-making was facilitated by creating subcategories of venous angioarchitecture and detailing the technical particularities in the corresponding category. Conclusion We described a novel treatment technique of transvenous embolization as an adjunct strategy for large bAVMs.