Surgical treatment for symptomatic pure arterial malformations: a single-center experience

Pure arterial malformations (PAMs) are rare cerebrovascular conditions characterized by dilated, tortuous arteries with a coil-like appearance, without venous components. Traditionally considered benign, PAMs are typically conservatively managed. However, their detection has increased with advancements in noninvasive imaging, and concerns about progression have emerged, with cases of cerebral hemorrhage or infarction being reported, raising questions about their benign nature and optimal treatment. Over nine years, our center surgically treated seven patients with symptomatic PAM, finding that PAMs are not invariably benign, especially in patients with aneurysm or prior stroke. We suggest that proactive surgical intervention, including malformation isolation or resection, complemented by cerebral bypass for vascular reconstruction, should be the preferred strategy. We also underscore the need for tailored management based on individual risk factors.