Management of Brain Arteriovenous Malformations

Brain arteriovenous malformations (AVMs) are vascular anomalies characterised by direct arterial‐to‐venous shunting through a central nidus, bypassing the capillary network. They carry a significant lifetime risk of intracranial haemorrhage, seizure and neurological deficit. Management is determined by lesion size, location, venous drainage pattern, patient age, clinical presentation and overall risk profile as assessed by established grading scales. Contemporary practice favours a multidisciplinary approach in specialised centres, combining microsurgical resection, stereotactic radiosurgery and endovascular embolisation either alone or in staged, multimodal sequences. Advances in high-resolution angiography, four-dimensional MR angiography and functional neuroimaging have refined pre-treatment planning, facilitating precise nidus delineation and mapping of eloquent cortex. Technological innovations in liquid embolic agents, detachable-tip microcatheters and frameless stereotactic systems have enhanced procedural safety and efficacy. Long-term surveillance utilises digital subtraction angiography or dynamic MR techniques to confirm complete obliteration. Emerging insights into molecular pathogenesis and patient-specific risk factors are informing personalised treatment algorithms. Globally, outcome improvements reflect more accurate risk stratification, refined operative tools and cohesive care pathways that balance obliteration rates with minimised morbidity.

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Management of Brain Arteriovenous Malformations publication trend

The graph below shows the total number of articles in management of brain arteriovenous malformations across all publications each year (not limited to Nature Index journals).

Technical terms

Arteriovenous malformation (AVM): A network of abnormal vessels connecting arteries directly to veins without an intervening capillary bed.

Embolisation: An endovascular procedure in which occlusive agents are delivered via a microcatheter to block pathological vessels.

Stereotactic radiosurgery: A non-invasive technique that uses focused radiation beams to induce progressive obliteration of the AVM nidus.

Nidus: The core of an AVM comprising tangled vessels that form the arteriovenous shunt.

Microcatheter: A fine, flexible catheter used in endovascular procedures to access and navigate small cerebral vessels.

References

1. A comprehensive analysis of patients with cerebral arteriovenous malformation with headache: assessment of risk factors and treatment effectiveness. The Journal of Headache and Pain (2024).
2. Glue, Onyx, Squid or PHIL? Liquid Embolic Agents for the Embolization of Cerebral Arteriovenous Malformations and Dural Arteriovenous Fistulas. Clinical Neuroradiology (2021).
3. Curative Embolization of Brain Arteriovenous Malformations with Onyx: Patient Selection, Embolization Technique, and Results. American Journal of Neuroradiology (2012).
4. Brain Arteriovenous Malformation Treatment Using a Combination of Onyx and a New Detachable Tip Microcatheter, SONIC: Short-Term Results. American Journal of Neuroradiology (2010).
5. Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation. American Journal of Neuroradiology (2014).
6. Somatic mutations in intracranial arteriovenous malformations. PLOS ONE (2019).
7. Cerebral Arteriovenous Malformations: Evaluation and Management. The Scientific World JOURNAL (2014).