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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Partial "targeted" embolisation of brain arteriovenous malformations
Timo Krings1, Franz-Josef Hans, Sasikhan Geibprasert
1Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, UHN, 399 Bathurst St., 3MCL-429, Toronto, ON M5T 2S8, Canada. timo.krings@uhn.on.ca
European Radiology
|June 11, 2010
Summary
Partial embolisation offers a targeted approach for treating brain arteriovenous malformations (AVMs). This strategy can secure ruptured AVMs or treat symptomatic unruptured AVMs by addressing specific pathomechanisms.
Area of Science:
- Neurology
- Neurosurgery
- Interventional Radiology
Background:
- Pial arteriovenous malformations (AVMs) treatment remains controversial due to limited understanding of natural history and pathomechanisms.
- Complete occlusion is necessary to prevent hemorrhage, but curative embolisation rates are 20-50% with acceptable risk.
- Existing knowledge gaps hinder optimal therapeutic strategies for brain AVMs.
Purpose of the Study:
- To explore the role of partial, targeted embolisation in managing pial arteriovenous malformations.
- To identify specific pathomechanisms and angioarchitectures amenable to targeted endovascular treatment.
- To provide examples of targeted embolisation strategies for acutely ruptured and symptomatic unruptured AVMs.
Main Methods:
- Review of existing literature on the treatment of pial arteriovenous malformations.
- Analysis of pathomechanisms and angioarchitectural features relevant to endovascular treatment.
- Case examples illustrating targeted embolisation for different AVM presentations.
Main Results:
- Partial, targeted embolisation can be a valuable strategy in specific AVM scenarios.
- In acutely ruptured AVMs, targeted embolisation can secure the malformation by occluding the bleeding source.
- Symptomatic unruptured AVMs with identifiable, treatable pathomechanisms may benefit from targeted endovascular approaches.
Conclusions:
- Targeted embolisation offers a viable treatment option for select pial arteriovenous malformations.
- This approach can stabilize acutely ruptured AVMs and manage symptomatic unruptured AVMs based on individual angioarchitecture.
- Further research into AVM pathomechanisms and targeted treatment efficacy is warranted.
