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Updated: Feb 12, 2026

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Contemporary tools in arteriovenous malformations surgery.

Marco Cenzato1, Flavia Dones2, Davide Boeris2

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Contemporary surgical techniques and advanced technologies significantly improve outcomes for arteriovenous malformations (AVMs). Enhanced intraoperative tools and team collaboration are crucial for successful AVM resection and patient recovery.

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Area of Science:

  • Neurosurgery
  • Interventional Neuroradiology
  • Medical Technology

Background:

  • Arteriovenous malformations (AVMs) present significant challenges in neurosurgery.
  • Debate exists regarding surgical indications for unruptured AVMs, particularly post-ARUBA study.
  • Recent multicenter reviews highlight the critical role of surgical intervention in AVM management.

Purpose of the Study:

  • To review current literature on contemporary tools for AVM treatment.
  • To illustrate technologies crucial for optimal surgical and clinical outcomes in AVM resection.

Main Methods:

  • Literature review focusing on advancements in AVM surgical management.
  • Discussion of key technologies including Indocyanin green, microbipolar clips, thulium laser, intraoperative ultrasound with neuronavigation, angiosonography, and color-Doppler.
  • Emphasis on functional preoperative studies, intraoperative monitoring, and hybrid operating room utilization.

Main Results:

  • Indocyanin green is a gold standard for identifying feeders, draining veins, and residual AVM.
  • Advanced tools like microclips and thulium laser enhance bleeding control and nidus removal.
  • Intraoperative ultrasound, neuronavigation, and Doppler technologies improve resection accuracy and flow assessment.

Conclusions:

  • Technological advancements are vital for overcoming AVM treatment challenges.
  • Hybrid operating rooms and collaborative neurovascular teams facilitate combined approaches for maximal AVM removal.
  • Preoperative functional studies and intraoperative monitoring are essential for decision-making, especially in eloquent brain areas.