Neurosurgery for Cerebral Arteriovenous Malformations (AVMs)

Abstract

Brain arteriovenous malformations comprise a large group of vascular lesions. This chapter focuses on cerebral arteriovenous malformations (AVMs) of the pia which are a type of arteriovenous shunt located within the subpial and/or subarachnoid space characterized by a network of abnormal channels (nidus) between the arterial supply and venous drainage. Cerebral AVMs remain a rare disease with a potentially morbid natural history. All treatment modalities have differences in specific risks, invasivity, or cure rates. Therefore the optimal management of brain AVMs is challenging and often involves a complex multidisciplinary decision-making process balancing the risks of any treatment modality alone or in combination with the risk of conservative management. This takes into account whether the AVM is ruptured or not, AVM-specific characteristics such as location, size, and angioarchitecture; patient-specific factors such as age, symptoms, and neurological and medical status; and, finally, also the specific expertise at the treating centers.