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Updated: Jun 27, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular treatment of intracranial microarteriovenous malformations
Alexander Andreou1, Ioannis Ioannidis, Shivendra Lalloo
1Department of Neurosurgery & Interventional Neuroradiology, Hygeia Hospital, Athens, Greece.
Object:
Microarteriovenous malformations (micro-AVMs) are an uncommon subgroup of brain AVMs defined by a nidus measuring < 1 cm in diameter. The clinical features, angiographic characteristics, and outcomes in patients with micro-AVMs who had been treated endovascularly after presenting with hemorrhage were reviewed to identify common features affecting prognosis.
Methods:
Between 1997 and 2006, 25 patients (12 females and 13 males) with 26 micro-AVMs were treated. Twenty-four patients presented with intracerebral hematoma and 1 with subarachnoid hemorrhage only. All patients underwent CT on admission, diagnostic cerebral angiography, and 1 session of endovascular treatment during the acute phase.
Results:
Procedure-related complications occurred in 3 patients (12%), which caused temporary hemiparesis in 1 (4%) and no clinical sequelae in 2 patients (8%). Complete nidus obliteration was achieved at the end of the embolization in 22 (84.6%) of 26 lesions. Two recurrences were evident on follow-up angiography 6 months postembolization, resulting in a complete obliteration rate of 77% (20 of 26 lesions) after a single treatment. Late angiography was performed in 12 patients, and no further recurrences were identified.
Conclusions:
Immediate complete obliteration of a micro-AVM with a high permanent cure and low morbidity rates was accomplished using endovascular treatment. Early embolization after bleeding should be considered as an alternative to resection.
Insights
Endovascular treatment effectively obliterates brain microarteriovenous malformations (micro-AVMs) after hemorrhage, offering a high cure rate and low complication risk. Early embolization is a viable alternative to surgical resection for these small vascular lesions.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Microarteriovenous malformations (micro-AVMs) are small brain vascular malformations (<1 cm nidus).
- These lesions are an uncommon subgroup of brain arteriovenous malformations (AVMs).
- Patients often present with intracranial hemorrhage.
Purpose of the Study:
- To review clinical features, angiographic characteristics, and outcomes of endovascularly treated micro-AVMs.
- To identify prognostic factors in patients with hemorrhagic micro-AVMs.
- To evaluate the efficacy and safety of endovascular treatment for micro-AVMs.
Main Methods:
- Retrospective review of 25 patients (26 micro-AVMs) treated between 1997 and 2006.
- All patients presented with hemorrhage (intracerebral or subarachnoid).
- Diagnostic cerebral angiography and one session of endovascular treatment during the acute phase were performed.
Main Results:
- Complete nidus obliteration was achieved in 84.6% of lesions after embolization.
- A single treatment resulted in a 77% complete obliteration rate after accounting for recurrences.
- Procedure-related complications occurred in 12% of patients, with temporary hemiparesis in 4%.
Conclusions:
- Endovascular treatment provides immediate complete obliteration of micro-AVMs.
- The treatment offers high permanent cure rates and low morbidity.
- Early embolization is a recommended alternative to surgical resection for bleeding micro-AVMs.
