Two-step presurgical endovascular treatment of five arteriovenous malformations partially fed by single vessels en passage

Pathophysiology and treatment of brain AVMs

Cerebral arteriovenous malformations (AVMs) are a major source of intracerebral hemorrhage in younger adults. First, some basic ideas about AVM anatomy, the influences of pressure, macrovascular flow, perfusion and the "steal effect", and some recent observations in the field of inflammatory markers and genetics are briefly discussed. Then, some clinical aspects in the presentation and the natural course of AVMs are highlighted, with special emphasis on the prediction of hemorrhage. Finally, some problems of the current treatment options are mentioned, and future directions in diagnostics and therapy considered.

Endovascular Treatment of Cerebral Arteriovenous Malformations

The modern management of cerebral arteriovenous malformations (AVMs) is based on three therapeutic modalities: microneurosurgery, endovascular embolization, and stereotactic radiosurgery. Embolization facilitates subsequent radiosurgery by reducing the volume of the nidus, prepares the resection of surgically accessible AVMs, and immediately addresses the risks related to associated intra/extranidal aneurysms and arteriovenous fistulas. We discuss in this article the current state of AVM endovascular therapy.