Management of brain arteriovenous malformations

Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, California 94110, USA.
Current Opinion in Anaesthesiology (Impact Factor: 1.98). 11/2005; 18(5):484-9. DOI: 10.1097/
Source: PubMed


This review highlights recent data regarding factors associated with brain arteriovenous malformation hemorrhage and different treatment options.
More risk factors were identified in association with intracranial hemorrhage, including age at initial diagnosis of arteriovenous malformation, co-existing extranidal aneurysms and genetic factors. Patients with unruptured arteriovenous malformations were found to be more susceptible to worsening in neurological function after microsurgery compared with those presenting with hemorrhagic arteriovenous malformation. Radiosurgery has achieved satisfactory obliteration of deep arteriovenous malformations, but with increased actuarial hemorrhage rates from the first to the fifth year. Although the Intraoperative Hypothermia for Aneurysm Surgery Trial failed to show a significant neurological improvement, the superior efficiency of endovascular cooling has offered optimism in cerebral protection during neurovascular surgeries by shortening the time to achieve hypothermia and rewarming. A multi-center trial (ARUBA) has been proposed to test the hypothesis that, for unruptured brain arteriovenous malformations, there is no difference between interventional and conservative management. Recent studies have also shown the promise of using tetracyclines to decrease the rate of spontaneous arteriovenous malformation rupture.
The recent identification of clinical and genetic factors associated with brain arteriovenous malformation hemorrhage, as well as studies on treatment outcomes, will help risk stratification in management choices. Future studies are needed to identify arteriovenous malformation patients at the greatest risk of spontaneous hemorrhage and to develop specific medical therapies.

6 Reads

  • [Show abstract] [Hide abstract]
    ABSTRACT: With the increasing range of conditions currently amenable to endovascular therapies, the knowledge of periprocedural blood pressure management is essential for the neurointerventional surgeon. This review discusses the physiology of cerebral blood flow and blood pressure, monitoring options for neurointerventional patients, useful agents for blood pressure elevation and reduction and neuroanesthetic considerations during procedures with an emphasis on practical decision-making. Also included are parameters for conditions typically encountered in the neurointerventional suite based on best available evidence, with reference to blood pressure management before, during and after neurointerventional therapy.
    Journal of Neurointerventional Surgery 03/2011; 3(1):66-73. DOI:10.1136/jnis.2009.001206 · 2.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Object: Arteriovenous malformations (AVMs) are classically described as congenital static lesions. However, in addition to rupturing, AVMs can undergo growth, remodeling, and regression. These phenomena are directly related to cellular, molecular, and physiological processes. Understanding these relationships is essential to direct future diagnostic and therapeutic strategies. The authors performed a search of the contemporary literature to review current information regarding the molecular and cellular biology of AVMs and how this biology will impact their potential future management. Methods: A PubMed search was performed using the key words "genetic," "molecular," "brain," "cerebral," "arteriovenous," "malformation," "rupture," "management," "embolization," and "radiosurgery." Only English-language papers were considered. The reference lists of all papers selected for full-text assessment were reviewed. Results: Current concepts in genetic polymorphisms, growth factors, angiopoietins, apoptosis, endothelial cells, pathophysiology, clinical syndromes, medical treatment (including tetracycline and microRNA-18a), radiation therapy, endovascular embolization, and surgical treatment as they apply to AVMs are discussed. Conclusions: Understanding the complex cellular biology, physiology, hemodynamics, and flow-related phenomena of AVMs is critical for defining and predicting their behavior, developing novel drug treatments, and improving endovascular and surgical therapies.
    Neurosurgical FOCUS 09/2014; 37(3):E1. DOI:10.3171/2014.7.FOCUS14214 · 2.11 Impact Factor