The treatment of brain arteriovenous malformations (AVMs) involves a multimodal approach, including embolization, microsurgical resection, and radiosurgery, often used in combination depending on the specific characteristics of the AVM and the patient's condition
Embolization
- Embolization can be performed as a stand-alone treatment or in conjunction with surgery or radiosurgery
- It is primarily reserved for small and low-grade AVMs, with outcomes highly dependent on patient selection and technique used
- However, embolization as a curative treatment for brain AVMs is often incomplete, and the risk of complications, including hemorrhage, is significant
Microsurgical resection
- Microsurgical resection is often used in combination with embolization, especially for larger AVMs
- Staged surgical resection may be necessary to minimize risks associated with sudden changes in cerebral hemodynamics
Radiosurgery
- Stereotactic radiosurgery is an effective treatment modality for small AVMs of the brain
- For larger AVMs, the treatment dose is often lowered to reduce potential complications, but this decreases the likelihood of cure. One strategy is to divide large AVMs into smaller anatomic volumes and treat each volume separately
- Radiosurgery significantly reduces the risk of first hemorrhage from brain AVMs
In conclusion, the treatment of brain AVMs is complex and requires a tailored approach based on the specific characteristics of the AVM and the patient's condition. The choice of treatment modality or combination of modalities should be made in a multidisciplinary setting, taking into account the potential benefits and risks of each approach