Endovascular treatment of arteriovenous malformations

Orlando M. Diaz, Robert Scranton

Research output: Chapter in Book/Report/Conference proceedingChapter

8 Scopus citations

Abstract

Cerebral arteriovenous malformations (AVM) are tangles of blood vessels that permit shunting of blood from the arterial to venous phase without intervening capillaries. The malformation's arterialization of a low-pressure system creates a risk of rupture that is substantially higher when associated with an aneurysm. The annual hemorrhage rate is 2.2% per year as reported in the randomized trial of unruptured brain AVMs (ARUBA; rupture risk is increased after the first event. Ruptured AVMs have a 10% mortality rate and 20%–30% morbidity rate. The treatment of choice for AVMs is microvascular resection with or without preoperative embolization. Surgical risk can be stratified based on the Spetzler-Martin grading system. Liquid embolic material and coils may be used for the treatment of AVM associated aneurysms, especially in the setting of acute rupture as a bridge to delayed surgical resection. There is some limited reported success in total endovascular treatment of AVMs, but this is not considered standard therapy at this time. Stereotactic radiosurgery (SRS) has been recently described but mainly limited to AMVs deemed too risky to approach in an open fashion and limited to 2.5 cm–3 cm in size. The delayed protection from hemorrhage (approximately 2–3 years) and high marginal failure/recurrence rate are the greatest concerns.

Original languageEnglish (US)
Title of host publicationNeuroimaging Part II, 2016
EditorsJC Masdeau, RG Gonzalez
PublisherElsevier B.V.
Pages1311-1317
Number of pages7
Volume136
ISBN (Print)9780444534866
DOIs
StatePublished - Dec 1 2016

Publication series

NameHandbook of Clinical Neurology
Volume136
ISSN (Print)00729752
ISSN (Electronic)22124152

Keywords

  • Arteriovenous malformation
  • flow-related aneurysm
  • microsurgical resection
  • Spetzler-Martin
  • stereotactic radiosurgery

ASJC Scopus subject areas

  • Medicine(all)
  • Neurology
  • Clinical Neurology

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