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Arteriovenous Malformations in the Brain.

Glenn D. Graham1

  • 1Cerebrovascular Disorders Program, Department of Neurology, The University of New Mexico School of Medicine and Albuquerque VA Hospital, 1501 San Pedro Drive, SE, Albuquerque, NM 87108, USA. graham@unm.edu

Current Treatment Options in Neurology
|October 2, 2002
PubMed
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Arteriovenous malformations (AVM) require definitive treatment due to lifelong bleeding risks. Microsurgery offers high cure rates for small AVMs, while radiosurgery and embolization serve as alternatives or adjuncts.

Area of Science:

  • Neurology
  • Neurosurgery
  • Interventional Radiology

Background:

  • Arteriovenous malformations (AVM) are a primary cause of intracerebral hemorrhage, particularly in younger populations.
  • AVMs present a continuous, lifelong risk of severe bleeding, necessitating definitive treatment for most patients.

Purpose of the Study:

  • To review current treatment modalities for cerebral arteriovenous malformations.
  • To highlight the strengths and limitations of microsurgery, radiosurgery, and endovascular embolization.
  • To emphasize the need for higher-level evidence to guide treatment decisions.

Main Methods:

  • Review of existing literature and treatment outcomes for AVMs.
  • Comparison of microsurgical resection, radiosurgery (gamma knife, LINAC, heavy ion), and endovascular embolization.

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  • Analysis of evidence levels (Class III) and expert opinion in current management strategies.

    • Main Results:

    • Microsurgical resection provides high cure rates and low morbidity for small, accessible AVMs.
    • Radiosurgery is an option for specific AVMs (<3 cm) or when surgery is contraindicated, but has lower cure rates and delayed obliteration.
    • Endovascular embolization is typically an adjunct therapy to reduce AVM size and bleeding risk before definitive treatment.

    Conclusions:

    • Treatment decisions for AVMs currently rely on limited evidence (Class III) and expert consensus.
    • Randomized clinical trials are essential to establish objective guidelines for optimal AVM management.
    • Multimodal approaches are often necessary for complex AVMs.