Pearls Acute management of ruptured iAVMs is driven by supportive care required for the intraparenchymal hemorrhage. Medical management focuses on seizure prophylaxis, blood pressure control, and intracranial pressure control. Structural imaging (CTA/MRA) and cerebral angiography can identify high-risk features and…
Pearls The risk for iAVM hemorrhage is uncertain during the latency period of SRS (i.e., time to obliteration ~ 2 years). Acute radiation effects are rare; headaches and seizures are easily treated. Early delayed effects of SRS (radiation-induced imaging changes)…
Pearls Each individual technique for treating AVMs has its own risk profile, and while often overlapping, there are some differences. Surgery carries a risk of infection relating to the craniotomy, retraction injury, cerebral contusion, hemorrhage, seizure, and so on. Radiosurgery…
Acknowledgments We thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation. Pearls Intracranial AVMs can be embolized for five different strategies: curative intent, preoperative, preradiosurgical, targeted, or palliative. The most common indication is preoperative…
Pearls Surgical risk at experienced centers can be accurately determined. Preoperative use of functional MRI, diffusion tensor imaging, and Wada testing along with routine MRI, CT angiography, and digital subtraction angiography greatly facilitates interventional risk assessment. Location, size, venous drainage,…
Pearls The annual bleeding risk from unruptured/asymptomatic iAVMs is 2%–3%. Intervention, usually surgery, is recommended for small iAVMs in noneloquent areas. Observation is often recommended for large iAVMs in eloquent areas. Age, projected duration of risk, and associated aneurysms are…
Pearls Palliation is reserved for symptomatic iAVMs deemed untreatable with surgery. Palliation includes partial embolization or staged stereotactic radiosurgery. The goal of palliation is to alleviate ischemic symptoms, headache, or seizures in patients with noncurable iAVMs. New innovative transvenous embolization…
Pearls The risk of hemorrhage dictates neurosurgical intervention for iAVMs. Stereotactic radiosurgery (SRS) is utilized when microsurgical resection of an iAVM is not possible due to location, size, feeding vessels, or medical comorbidities that preclude resective surgery. Embolization is often…
Acknowledgments We thank Paul H. Dressel BFA for research assistance on the illustrations and Debra J. Zimmer for editorial assistance. Pearls Endovascular techniques are practiced in four different settings in the treatment of iAVMs, each with an associated goal: adjunctive…
Disclosure Dr. Lunsford is a stockholder of AB Elekta and DSMB chair for Insightec, Inc. Pearls Stereotactic radiosurgery has become the most frequently used option for the treatment of iAVMs. The goal is AVM obliteration, which is related to AVM…