Intracranial Arteriovenous Malformations

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Surgical Innovations

Pearls Advances in knowledge regarding the natural history of iAVMs and indications for surgery have enhanced patient selection for specific treatment modalities. Imaging modalities allow for precise determination of nidus size, intranidal aneurysm presence, and characterization of arterial feeders and…

Molecular Biology and Novel Treatments of Intracranial AVMs

Acknowledgments We thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation. Pearls The dynamic nature of iAVMs is ascribed to complex molecular and physiologic processes that contribute to their growth, regression, remodeling, and de…

Radiosurgical Innovations

Pearls Stereotactic radiosurgery is a reasonable and well-studied treatment strategy for AVM patients. Treatment success and complication profiles are a function of AVM nidus, cortical eloquence, and overall AVM flow. Strong predictive models remain an area of research. Innovations in…

Imaging Predictors for Rupture

Pearls The effective assessment of iAVMs relies on both MRI (parenchymal imaging) and catheter angiography. Directed evaluation of these studies provides predictors of AVM rupture risk. Treatment response to open surgery, endovascular embolization, or radiosurgery requires imaging assessment. AVM location,…

The Value of a Registry

Pearls The management of iAVMs is controversial. The randomized control trial (RCT) results from ARUBA (A Randomised Trial of Arteriovenous Malformations) have added to this controversy. Registry-based studies are observational studies focused on a specific clinical disease, patient population, or…

Intraoperative AVM Rupture

Acknowledgment We thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation. Pearls Intraoperative bleeding from an iAVM is best categorized as arterial, venous, or nidal. Arterial bleeding is best managed with bipolar cautery directly…

Residual AVMs

Pearls The treatment of residual iAVMs is complex and best avoided with appropriate planning and execution of the initial procedure(s). Intraoperative angiography, indocyanine green fluorescence, and provocative hypertension are very useful for ruling out residual iAVM at the time of…

Pediatric AVMs

Pearls Pediatric iAVMs tend to present as symptomatic lesions. Early management centers around general principles of intracranial pressure management, assessment of need for hematoma evacuation, and identification of high-risk angiographic features. Symptomatic pediatric iAVMs carry a much more substantial risk…

AVMs of the Sylvian Fissure

Pearls Sylvian fissure AVMs are very frequently related to eloquent cortex anatomically or by virtue of vascular anatomy. Permanent morbidity after resection ranges from 0% to 34%. Classification is based upon anatomical location within (pure sylvian) or around (perisylvian) the…