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Arteriovenous Malformations and Other Vascular Anomalies

Abstract:

Intracerebral vascular malformations constitute an important cause of intracranial hemorrhage in younger patients. The spectrum of vascular malformations ranges from sporadic congenital lesions such as brain arteriovenous malformations (AVMs), to genetically determined familial disorders that may progress over time. Arterial aneurysms, moyamoya disease, and arteriovenous dural fistulas are considered acquired lesions. Developmental venous anomalies represent a variant of physiologic venous drainage and pose minimal, if any, risk of becoming symptomatic. Among the “true” vascular malformations, only cerebral cavernous malformations and AVMs are of clinical relevance, while capillary telangiectasias constitute asymptomatic, incidental imaging findings. Surgical treatment indications for cerebral cavernous malformations are limited. Neurosurgical excision is generally offered for cavernous malformations associated with therapy-resistant epilepsy, progressive neurologic deficit, enlargement of the lesion, or symptomatic intracerebral hemorrhage. Brain AVMs are usually treated after they become symptomatic with hemorrhage. Intervention of unruptured brain AVMs has been associated with a higher risk of stroke and neurologic deficits than medical management. The discussion of treatment options for patients with asymptomatic AVMs should include the risks of the intervention versus the risk of hemorrhage based on the angio-architecture of the lesion and life expectancy of the patient.