Figure 52.1. Example of MAV 1.

52.9 Conclusions and Key Points

• Intracranial hemorrhage is the most common form of presentation of AVMs.
  
• The presence of aneurysms in the feeding arteries or the nidus and the blockage of drainage increases the likelihood of rupture and hemorrhage.
  
• The Martin-Spetzler classification provides information on the risk of surgery but does not predict the risk of rupture or bleeding.
  
• AVMs are complex lesions and are commonly treated with a combination of embolization, microsurgery or stereotactic radiosurgery.
  
• Occlusion of the malformation (microsurgery or embolization) can result in bleeding due to rupture or damage to adjacent tissue reperfusion.
  
• The gradual embolization of the malformation and the strict control of blood pressure are the best way to avoid complications.
  
• Vasodilator agents such as nicardipine may be used during the early hours to control blood pressure.

References

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2. Olgilvy CS, Klassen A, Wellman T, et al. Feeding arterial rigidity and hemodynamics of cerebral arteriovenous malformations. In: Bevan, RD, and Bevan, JA (ed.) The human brain circulation: Functional changes in disease. New Jersey, USA: Humana Press, 1994; pp. 405-12

3. Brown RD, Wiebers DO, Forbes G, et al. The natural history of unruptured intracranial arteriovenous Malformations. J Neurosurg 1988, 68: 352-7

4. Kikuchi K, Kowada M, Sasajima H. Vascular Malformations of the brain in hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease). Surg Neurol 1994; 41: 374-80

5. Laufer L, Cohen A. Sturge-Weber syndrome associated with a large arteriovenous malformation Hemispheric left. Pediatr Radiol 1994; 24: 272-3

6. Hamilton MG, Spetzler RF. The prospective application of a system for arteriovenous Malformations gradding. Neurosurgery 1994; 34: 2-6

7. Maruyama K, Kawahara N, Shin M, et al. The Risk of cerebral hemorrhage alter radiosurgery for arteriovenous Malformations. N Engl J Med 2005; 352: 146-53

8. Friedman WA, Bova FJ, Mendenhall WM. Linear accelerator radiosurgery for arteriovenous Malformations: The Relationship of size to outcome. J Neurosurg 1995; 82: 180-9

9. Wikholm G, Lundqvist C, Svendsen P. The Goteborg cohort of embolized cerebral arteriovenous malformations: a 6-year follow up. Neurosurgery 2001; 49: 799-806

10. Flickinger JC, Kondziolka D, Lunsford LD, et al. A multi-institutional analysis of arteriovenous malformation Complication radiosurgery alter outcomes. Int J Radiat Oncol Biol Phys 1999; 44: 67-74

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