Memory-driven capture during focused visual attention.

Attention can be captured by the presence of distractors that match the current content of working memory in the visual field. This memory-driven capture is well established when observers adopt diffused attentional settings prior to the onset of memory-matching distractors. However, it remains unclear whether memory-driven capture can occur when observers are in a state of focused attention. The present study attempted to address this question by examining whether memory-matching distractors can disrupt performance on a focused attention task. Participants were asked to hold a sample word in working memory and then had to name a central color while ignoring an irrelevant distractor word in the visual display. In Experiments 1 and 2, the distractor word was always presented centrally within the focus of attention. In Experiment 3, the distractor word could be presented either at the center or at the periphery (i.e., outside the focus of attention). The results showed that the irrelevant distractor word within the focus of attention interfered with color-naming performance when it matched the sample word held in working memory. However, no interference effect was observed when the distractor word was presented outside the attentional focus. The present findings indicate that working memory-driven capture during a state of focused visual attention depends crucially on whether or not memory-matching distractors are positioned within the focus of attention.

Electric-Double-Layer Origin of the Kinetic pH Effect of Hydrogen Electrocatalysis Revealed by a Universal Hydroxide Adsorption-Dependent Inflection-Point Behavior.

The mechanism of the kinetic pH effect in hydrogen electrocatalysis, that is, the order-of-magnitude kinetic gap between the hydrogen oxidation and evolution reactions (HOR/HER) in acidic and alkaline electrolytes, has been drastically explored but still intractable to reach a consensus, which severely limits the catalyst advance for alkaline-based hydrogen energy technologies. Herein, the HOR/HER kinetics on a number of precious metal-based electrocatalysts are evaluated in electrolytes with pHs spanning a wide range from 1 to 13. Instead of a monotonous decrease with pH as generally believed, we surprisingly find a universal inflection-point behavior in the pH dependence of HOR/HER kinetics on these catalysts, with both the inflection-point pH and the acid-alkaline activity gap depending on the hydroxide binding energy of the catalyst. Based on a triple-path microkinetic model, in which hydronium (H3O+) and water (H2O) with and without formation of adsorbed hydroxide (OHad), respectively, act as hydrogen donors participating in HOR/HER in various pHs, we reveal that the formation of OHad should promote the HOR/HER kinetics mainly by improving the hydrogen-bond network in the electric double layer (EDL), rather than merely through modulating the energetics of surface reaction steps such as disassociation/formation of water. The present results and conclusions indicate that it is the interfacial EDL that dominates the substantial kinetic pH effects of hydrogen electrocatalysis.

Hydroxyl-Binding Energy-Induced Kinetic Gap Narrowing between Acidic and Alkaline Hydrogen Oxidation Reaction on Intermetallic Ru3 Sn7 Catalyst.

Developing highly efficient catalysts toward alkaline hydrogen oxidation reaction (HOR) and narrowing the kinetic gap between acidic and alkaline electrolytes are of great importance for the practical application of alkaline exchange membrane fuel cell . Herein, ordered Ru3 Sn7 /C intermetallic compound has been developed for the HOR under alkaline and acidic conditions. The authors demonstrate that the ordered intermetallic Ru3 Sn7 /C shows much enhanced HOR activity, stability, and CO-tolerance compared with its disordered RuSn solid solution alloy counterpart. More importantly, the authors find that the kinetic gap of HOR between acidic and alkaline media is significantly narrowed in the as-synthesized intermetallic Ru3 Sn7 /C catalysts. Combined experiment results and theoretical calculations, the authors understand that promoted hydroxyl-binding energy on Ru3 Sn7 /C derived from the intermetallic-induced strong electron interaction is responsible for the accelerated alkaline HOR performance and narrowed kinetic gap.

Angiographic Types of Palpebral Arteriovenous Malformations and Relevant Therapeutic Options Based on Ethanol Embolization: A Multicenter Study.

PURPOSE: The present work aimed to determine the different angio-architectural types of palpebral arteriovenous malformations (pAVMs) and appropriate ethanol embolotherapy for each type. MATERIALS AND METHODS: This was a multi-center comparative effectiveness research retrospectively conducted from November 2012 to October 2021. A total of 70 patients with pAVMs were included, which was classified into cystic pAVMs (n=29) and diffuse pAVMs (n=41) based on the angio-architecture. Of the included patients, 17 with cystic pAVMs and 13 with diffuse pAVMs underwent ethanol embolization combined with coils (CE). The remaining participants underwent no-coil ethanol embolization (NCE). Participants had undergone 60 months of follow-up. Normality of data was tested by the D'Agostino and Pearson test. Correlation was tested by the Pearson χ2 test. Deterioration-free survival (DFS) rate was estimated using the Kaplan-Meier survival analysis. Multivariate Cox regression models included variables that were significant at a p value<0.05 in the univariate analysis to screen the prognostic factor. RESULTS: The local symptoms of pAVMs, including pulsation, warmth, red plaque, blepharoptosis, bleeding, and visual blurring, along with the devascularizational grade of angiography were recorded before and after the respective procedures. Post-treatment complications were either evaluated at the 3-month routine follow-up or were self-reported by patients. Cystic pAVMs presented with significantly different clinical and angiographic features compared with diffuse pAVMs. With CE, patients with cystic pAVMs obtained a higher devascularizational grade (p<0.0001) and better clinical outcomes (p=0.0009) than those with diffuse pAVMs. Contrarily, with NCE, patients with diffuse pAVM had better outcomes than those with cystic pAVMs (p=0.0248). Moreover, the overall DFS rate was higher in patients with cystic pAVMs (p=0.0006). Finally, the angio-architecture of pAVMs was found to independently influence its prognosis (p=0.02). CONCLUSIONS: In pAVMs, the angio-architectural type was associated with the relative prognostic status. Ethanol embolization combined with coils was an effective method to treat cystic pAVMs, whereas NCE was more suitable for the diffuse type, further emphasizing the importance of a type-based therapeutic strategy for pAVMs. CLINICAL IMPACT: Palpebral arteriovenous malformations (pAVMs) are rare and tricky in clinical practices. The present study has divided the pAVMs into cystic and diffuse types according to their angiographic characteristics. Ethanol embolization with (CE) or without coils (NCE) was performed on both types. CE was suitable for cystic pAVMs; whereas NCE was a better choice for diffuse pAVMs. The five-year survival analyses provided evidence of the safety and efficacy of ethanol application in pAVMs. Finally, our work demonstrated that both the short- and long-term clinical outcomes of diffuse pAVMs were poor compared to those of cystic pAVM.

Ethanol Embolization of Chest Wall Arteriovenous Malformations: Four-Year Findings.

OBJECTIVES: To summarize the clinical characteristics and investigate the efficacy of ethanol embolotherapy in the treatment of chest well arteriovenous malformation (AVM). Treatment-associated complications were also explored. MATERIALS AND METHODS: Between March 2017 and August 2021, 32 consecutive patients (mean age, 23.7 years; age range, 5-54 years) who underwent ethanol embolotherapy for chest well AVMs under general anesthesia were included in this study. Embolization was performed through a direct puncture, transarterial catheterization, or a combination of the 2 procedures. The mean follow-up duration after the last treatment was 18.0 months (range, 3-42 months). The degree of devascularization on follow-up (assessed using angiography or computed tomography), and the clinical signs and symptoms of AVMs were evaluated as the therapeutic outcomes. The major and minor complications associated with the procedures were recorded. RESULTS: A total of 103 embolization procedures (mean, 3.2; range, 2-7) comprising 101 ethanol embolization and 2 coil embolizations were performed on 32 patients with chest wall AVMs. The AVM nidus was accessed through the transarterial approach alone in 4 patients, by direct puncture in 11, and a combined procedure in 17 patients. Overall, more than 80% of the procedures were performed using the combined approach. Complete AVM devascularization was achieved in 12 (37.5%) patients. Moreover, 76% to 99% AVM was achieved in 18 patients (56.3%), and 50% to 75% in 2 patients (6.3%). Bleeding, pain, heart failure, and cosmetic deformities were the indications for treatment. For 3 patients (3/32, 9.4%) who had bleeding, the treatment stopped the hemorrhage. Complete pain relief was reported in 8 patients (8/32, 25.0%), whereas complete relief from congestive heart failure post-embolization was observed in 5 of the 6 patients with congestive heart failure (5/6, 83.3%). Complete correction of cosmesis deformities after embolization was achieved in 10 patients (10/32, 31.3%). Two patients who underwent surgery to correct persistent deformity after embolization only showed insignificant improvement. In addition, 6 (18.8%) patients developed 13 complications including blister, necrosis, hemothorax, transient hemoglobinuria, and transient pulmonary artery hypertension. CONCLUSIONS: Ethanol embolotherapy is a safe and effective procedure for chest well AVMs. Surgery is required for some patients with residual cosmesis deformity. CLINICAL IMPACT: Currently, there is no standard treatment for chest well AVMs due to their rarity and high heterogeneity. The present study shows that thanol embolotherapy is a safe and clinically effective treatment procedure for the chest well AVMs. Transarterial embolization in combination with direct puncture embolization can reach the AVM nidus. Ethanol embolotherapy can achieve complete obliteration of the AVM nidus in the majority of patients. Surgery may still be needed to correct cosmetic deformity after embolization. The present study provides valuable evidence to inform clinical decision-making.

Comprehensive analysis of exosomal circRNA, lncRNA, and mRNA profiles to identify the potential RNAs involved in the pathogenesis of venous malformation.

BACKGROUND: Venous malformation (VM) is a kind of congenital vascular anomaly with a high incidence of recurrence, detailed pathogenesis and standard treatment of VM still lack now. Increasing evidence showed exosomal RNA plays a pivotal role in various diseases. However, the underlying mechanism of VM based on the potential differentially exosomal RNAs remains unclear. METHODS: Comparative high-throughput sequencing with serum exosomes from three VM patients and three healthy donors was used to explore differentially expressed (DE) circRNAs, DE lncRNAs, and DE mRNAs involving the formation of VM. We identified and verified DE circRNAs, DE lncRNAs, and DE mRNAs via qRT-PCR assay. We explored the potential functions of these exosomal DE non-coding RNAs via performing further Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis. Besides, circRNA/lncRNA-miRNA-mRNA linkages were also constructed to find their potential relationships in VM. RESULTS: A total of 121 circRNAs, 53 lncRNAs, and 42 mRNAs (|log2 FC| ≥ 2.0, FDR <0.05, n = 3) were determined to be differentially expressed. QRT-PCR validated that these top-changed DE circRNAs, lncRNAs, and mRNAs had significant expression changes. Functional studies demonstrated that DE circRNAs play a pivotal role in thyroid hormone signaling pathway, DE lncRNAs function as a key regulator in MAPK signaling pathway and DE miRNAs participate in the process of hepatocellular carcinoma mostly. CONCLUSION: Our study comprehensively depicted exosomal DE non-coding RNAs networks related to the pathogenesis of VM which can provide new insight into, a novel target for treating VM.

The Role of Discrepant Reactive Intermediates on Ru-Ru2 P Heterostructure for pH-Universal Hydrogen Oxidation Reaction.

Developing highly efficient electrocatalysts for hydrogen oxidation reaction (HOR) under alkaline media is essential for the commercialization of alkaline exchange membrane fuel cell (AEMFC). However, the kinetics of HOR in alkaline media is complicated, resulting in orders of magnitude slower than that in acid, even for the state-of-the-art Pt/C. Here, we find that Ru-Ru2 P/C heterostructure shows HOR performance with a non-monotonous variation in a whole pH region. Unexpectedly, an inflection point located at pH≈7 is observed, showing an anomalous behavior that HOR activity under alkaline media surpasses acidic media. Combining experimental results and theoretical calculations, we propose the roles of discrepant reactive intermediates for pH-universal HOR, while H* and H2 O* adsorption strengths are responsible for acidic HOR, and OH* adsorption strength is essential for alkaline HOR. This work not only sheds light on fundamentally understanding the mechanism of HOR but also provides new designing principles for pH-targeted electrocatalysts.

Absolute Ethanol Embolization of Lip Arteriovenous Malformations: Observational Results from 10 Years of Experience.

PURPOSE: To evaluate the safety and efficacy of ethanol embolization of lip arteriovenous malformations (AVMs). MATERIALS AND METHODS: Seventy-six patients with lip AVMs were treated with 173 ethanol embolization procedures. Lip AVMs were treated with direct puncture alone in 21 patients (35 procedures, 20.2%), transarterial embolization alone in 13 patients (18 procedures, 10.4 %), and a combination of both in 60 patients (120 procedures, 69.3%). Adjunctive surgical resection was performed after embolization for cosmetic purposes based on the patient's request, including patient preference, functional impairment, and skin necrosis. The mean duration of follow-up was 30.9 months ± 27.6. The follow-up included clinic visits and telephonic questionnaires to evaluate the clinical signs and symptoms of AVMs as well as quality of life measures. RESULTS: Of 76 patients, 51 showed 100% devascularization of AVMs, as determined using arteriography, followed by 23 with 76%-99% devascularization and 2 with 50%-75% devascularization. Of the 76 patients, 40 achieved complete symptom relief and 25 achieved major improvements in cosmetic deformity after embolization. Additionally, 54 patients achieved satisfactory function and aesthetic improvement with ethanol embolotherapy alone, whereas 22 achieved similar outcomes with a combination of ethanol embolotherapy and surgical intervention. Thirty-three adverse events (including 1 major) were documented. CONCLUSIONS: Ethanol embolization of lip AVMs, as a mainstay, is efficacious in managing these lesions, with acceptable complications. Surgical resection after embolization may improve function and cosmesis in a subset of patients.

Serum differentially expressed angiogenic cytokines in head and neck vascular malformations.

BACKGROUNDS: Head and neck vascular malformation (HNVM) is a highly complex congenital condition that is difficult to diagnose, monitor and treat. Therefore, it is critical to explore serum cytokines that may be related to its pathology and prognosis. METHODS: An antibody-based microarray was used to examine the expression of 31 angiogenic cytokines in 11 HNVM patients relative to 11 healthy subjects. ELISA was used to verify the results. We performed Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses of the differentially expressed cytokines (DECs). Additionally, we explored the function of DECs in human umbilical vein endothelial cells (HUVECs) in vitro via CCK-8, wound healing, transwell and tube formation assays. RESULTS: Expression of interleukin (IL)-10, matrix metallopeptidase-9 (MMP-9) and vascular endothelial growth factor receptor 2 (VEGF-R2) in HNVM patients was significantly higher, whereas levels of IL-12p40 and angiostatin were significantly lower in HNVM patients relative to healthy controls (p < 0.05). However, ELISA only verified that IL-10, MMP-9, VEGF-R2 and IL-12p40 had significant expression changes. Functional enrichment analysis revealed DECs mainly participated in the RAS signalling pathway. Functional studies demonstrated that IL-10, MMP-9 and VEGF-R2 promote cell proliferation, migration, invasion and tube formation, while IL-12p40 inhibited these processes in HUVECs. CONCLUSIONS: The present study not only indicates that IL-10, MMP-9, VEGF-R2 and IL-12p40 may participate in the development of HNVMs but also provides a theoretical basis for the discovery of new targeted molecules in the treatment of HNVMs.

Trans-ophthalmic arterial ethanol embolotherapy for arteriovenous malformations: a single-center experience.

Arteriovenous malformation (AVM)-derived ophthalmic artery (OphA) branches are not common, and their management is very challenging. We evaluated the safety and efficacy of Trans OphA ethanol embolotherapy for these lesions. We retrospectively reviewed 26 patients with AVMs fed by OphA, who underwent transOphA embolization using ethanol from February, 2015 to December, 2019. Sixty-six transOphA embolotherapy procedures (range, 1-4 procedures; mean, 2.5 procedures) were performed. Devascularization degree, visual field, visual acuity, and quality-of-life outcomes were compared and analyzed at follow up (mean, 32.6 months; month range 10-60). Complications were recorded. Twenty-five of the 26 patients (96%) reported complete or > 90% AVM devascularization while one patient (4%) showed > 70% devascularization. Eleven patients (42%) presented with visual acuity impairments; among them, 6 had improvements while 4 were completely relieved. Eight patients (30.7%) presented visual field defects, 3 had improvements while 4 were completely relieved. Ten patients (38.4%) presented with diplopia and exophthalmos with 2 being completely relieved while 6 had major improvements. Bleeding was controlled in all cases (100%). All patients (100%) exhibited cosmetic deformities with 17 being completely relieved. Moreover, all patients (100%) exhibited impaired daily life, which was resolved in 21 patients with 5 patients reporting major improvements. After endovascular treatment, there was no vision loss, death, or permanent disability in any patient. TransOphA ethanol embolotherapy is efficacious and safe for symptomatic resolution or improvement of AVMs fed by OphA with acceptable complications without the risk of visual impairment.

Cell-free DNA from plasma as a promising alternative for detection of gene mutations in patients with Maffucci syndrome.

Maffucci syndrome (MS, OMIM 166000) is an extremely unusual, nonhereditary, multisystemic disorder that is characterized with multiple enchondromas and vascular lesions, most of which are spindle cell hemangiomas. Complications of MS, such as bone deformities and dysfunction caused by enchondromas, usually increase during childhood and adolescence. Malignant transformation of enchondromas and other malignancies are the most severe complications. MS is caused by somatic mosaic IDH1/2 mutations, 65% of which are the IDH1 p.Arg132Cys variant. Due to its rarity, there is no international consensus for the most appropriate treatment option of MS.Here, we report a case of a female patient presenting with multiple enchondromas and spindle cell hemangiomas (SCHs) on bilateral hand and feet diagnosed as MS. A detailed clinical, pathological and genetic diagnosis of MS was rendered. Integrative Genomics Viewer (IGV) visualization of next-generation sequencing (NGS) data revealed the consistent detection of the low-frequency somatic IDH1 p.Arg132Cys mutation between SCH tissue and cystic blood-derived cfDNA. This is the first successful molecular diagnosis of MS complicated with SCH utilizing minimally invasive cfDNA techniques. We suggest that cfDNA sequencing could potentially be used as an alternative, reliable and sensitive method to identify molecular information for genetic diagnosis and for future targeted therapies of MS.

Embolization for Arteriovenous Malformations in the Maxilla With Coils and Ethanol.

PURPOSE: Maxillary arteriovenous malformations (AVMs) are uncommon, limiting comprehensive research into standard treatment protocols. This study evaluated the management, outcomes, and clinical safety of embolization techniques for maxillary AVMs, using coils and ethanol. METHODS: In this retrospective case series, we enrolled a sample of patients with maxillary AVMs treated with embolization using coils with or without ethanol between June 2017 and July 2019. Coils were super-selectively placed into the nidus and dominant outflow vein to decrease the flow of the arteriovenous fistulas. Absolute ethanol was then injected to obliterate the nidus. Clinical follow-up was performed for all the patients, and therapeutic outcomes were measured by evaluating the degree of devascularization and symptoms. RESULTS: Ten patients were included in the present study, including 4 men (40%) and 6 women (60%), with a mean age of 18.1 years (range, 10 to 36 years). Transvenous release of coils (9 detachable coils and 143 pushable coils), either with or without absolute ethanol embolization, was used in all the patients. The amount of ethanol injected ranged from 0 to 12 mL (mean: 6.5 mL; 95% confidence interval: 3.489 to 9.511) in a single session. Seven (70%) of the 10 patients were cured, while 3 patients (30%) had partial remission. Follow-up times ranged from 26 to 42 months (median: 29.7 months). Tooth loosening and coil exposure occurred in 7 patients (70%) and healed after surgery. No major complications were noted. CONCLUSIONS: Coils and ethanol embolization have the potential to cure AVMs in the maxilla with an acceptable risk of minor complications.

Ethanol embolization of lingual arteriovenous malformations: Positive experience in 52 patients during 11 years.

OBJECTIVE: Lingual arteriovenous malformations (AVMs) are extremely rare in clinical practice, which has limited comprehensive research to find standard treatment protocols. This study summarizes the clinical features of lingual AVMs and assesses the safety and efficacy of ethanol embolotherapy in the management of these lesions. METHODS: Our study group was composed of 52 patients with lingual AVMs treated by ethanol embolization, all of whom received general anesthesia. The optimal access to the nidus of the AVM was by direct puncture, transarterial catheterization, transvenous catheterization, and a combination of these routes. Pure ethanol was manually injected into the nidus of the AVMs. The observed major or minor complications related to ethanol embolization were analyzed, and periodic follow-up of the patients was performed. The devascularization of the lingual AVMs between baseline and final angiography and the clinical outcomes of symptoms and signs after ethanol embolization were evaluated. RESULTS: There were 171 embolization procedures (mean, 3.3; range, 1-20) including 166 ethanol embolizations performed; the average volume of ethanol injected in a single ethanol embolization session was 29.8 mL (range, 1-65 mL). Therapeutic outcomes were complete response in 17 patients (33%), partial response in 33 patients (63%), and no response in 2 patients (4%). The effective therapeutic outcomes were gained in 96% of the patients with lingual AVMs treated with ethanol embolization; 25 (48%) of the patients had 83 complications, which were necrosis, infection, hemorrhage of the puncture point, transient hemoglobinuria, postoperative irritability, airway constriction, and coil migration, occurring in 78 procedures (46%). Regular follow-up of all the patients was performed, with the average follow-up period of 37.9 months (range, 1-125 months) after the last treatment. CONCLUSIONS: Ethanol embolization of lingual AVMs is safe and efficacious and is recommended to be the potential preferred method in the treatment of these complicated lesions.

Intraosseous Arteriovenous Malformations in the Extremities Managed with Coils and Absolute Ethanol Treatment.

BACKGROUND: The extremity intraosseous arteriovenous malformations (AVMs) are rare high flow vascular lesions for which the treatment remains challenging. The aim of the study wasto assess treatment methods, interim results, and complications of coils and absolute ethanol in managing extremity intraosseous AVMs via direct puncture approach. METHODS: From 2009 to 2017, 12 patients (mean age, 27.5 years; range, 3-54 years) with extremity intraosseous AVMs underwent staged coils and absolute ethanol treatment via the direct puncture approach. All patients were symptomatic before the procedure as per the Schobinger staging system. The mechanical detachable coils and undetachable coils were used first followed by the injection of absolute ethanol used as a sclerosant agent via a direct puncture approach. Follow-up evaluation (6 to 72 months; mean, 23.5 months), including imaging and symptoms and signs, was performed in all patients. RESULTS: Twenty-seven absolute alcohol procedures were performed for patients with intravascular sclerosis (range: 1-3, mean: 2) with one procedure required per patient (n = 2), 2 per patient (n = 5), or 3 per patient (n = 5). The average stretched length of the total coils per patient was 843.33 cm. The amount of absolute ethanol used ranged from 10 mL to 45 mL (mean, 25.69 mL) in a single session. Nine of twelve patients (75%) exhibited complete responses, and 3 patients (25%) exhibited partial responses. One patient experienced minor complication of transient motor nerve injury and completely recovered half a month later. No major complications occurred. CONCLUSIONS: The study provides strong evidence, suggesting that direct puncture and coils with absolute ethanol approach is an effective and safe treatment in patients with extremity intraosseous AVMs, yielding minor complications and good results.

Embolotherapy for High-Flow Arteriovenous Malformations in the Hands Using Absolute Ethanol with Coil-Assisted Dominant Outflow Vein Occlusion.

PURPOSE: The purpose of this study was to evaluate the management, outcomes, and technical and clinical safety of coil-assisted dominant outflow vein (DOV) occlusion for the ethanol embolization of high-flow arteriovenous malformations (AVMs) in the hands. MATERIALS AND METHODS: Between March 2013 and October 2016, 12 consecutive patients with AVMs with DOVs underwent ethanol embolization combined with detachable and pushable coil-assisted DOV occlusion. All patients completed the course of clinical follow-up (range: 14-57 months; mean: 36.7 months), and imaging follow-up (range: 8-25 months; mean: 16.6 months) results from the final treatment session were available for 8 patients. The therapeutic effects, degree of devascularization, and complications at the time of follow-up arteriography were evaluated as the clinical outcomes. RESULTS: The patients underwent 23 ethanol embolization procedures (range: 1-3; mean, 1.9) with 24 detachable coils and 223 pushable coils. The average stretched length of the total coils per patient was 320.17 cm. Seven of 12 patients (58.3%) exhibited complete responses, and 5 patients (41.7%) exhibited partial responses. Minor complications, including blistering and focal swelling, occurred in all 12 patients (100%) but showed spontaneous and complete recovery. No major complications occurred. CONCLUSIONS: Ethanol embolization has the potential to control high-flow hand AVMs by using coil-assisted DOV occlusion with an acceptable risk of minor and major complications.

Absolute Ethanol Embolization Combined with Surgical Resection of Scalp Arteriovenous Malformations: Interim Results.

PURPOSE: To assess treatment methods, interim results, and complications of absolute ethanol embolization combined with surgical resection of scalp arteriovenous malformations (AVMs). MATERIALS AND METHODS: From September 2012 to January 2015, 15 consecutive patients (8 male and 7 female) with scalp AVMs underwent staged ethanol embolizations. Ethanol embolization was performed using transcatheter and/or direct puncture techniques. Ten patients with scalp AVMs with a dominant outflow vein (DOV) also underwent coil deployment before ethanol embolization. Two patients underwent surgical resection after ethanol embolization was achieved. Follow-up evaluations included clinical outcome of symptoms and signs and imaging at 1.5 months, 6 months, and annually thereafter. RESULTS: In 15 patients, 33 ethanol embolizations were performed; 16 coil deployments were performed in 10 patients who had scalp AVMs with a DOV. Of 15 patients, 8 (53.3%) were cured, 2 of whom underwent surgical resection. All 8 patients showed no recurrence in the follow-up period (range, 12-48 months; mean, 25 months). Seven patients (46.7%) had partial remission and will need further treatment sessions for residual AVMs (range, 1-12 months; mean, 7 months). In 3 of 15 patients (20%), 7 minor complications (skin blisters and necrosis) occurred. All minor complications healed with wound dressing and observation. There were no major complications. CONCLUSIONS: Ethanol embolization has the potential for cure in management of scalp AVMs, with an acceptable risk of minor and major complications. Once AVMs are devascularized, surgical resection can be performed to improve cosmetic results.