Multimodality Management of Cerebral Arteriovenous Malformations with Special Reference to AVM-Related Hemorrhages During Ongoing Staged Treatment

  • Andreas Gruber
  • Gerhard Bavinzski
  • Klaus Kitz
  • Stephan Barthelmes
  • Magdalena Mayr
  • Engelbert Knosp
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 123)


In this study we report and analyze the results of a multimodality management concept for intracranial arteriovenous malformations (AVMs), including microsurgery, embolization, and gamma knife radiosurgery. The study population consists of a consecutive series of 294 patients treated for 304 intracranial AVMs over a 10-year period.


Arteriovenous malformation Microsurgery Embolisation Radiosurgery Multimodality Management Re-hemorrhage 


Conflict of Interest Statement

We declare that we have no conflict of interest.


  1. 1.
    Choi JH, Mohr JP (2005) Brain arteriovenous malformations in adults. Lancet Neurol 4:299–308CrossRefPubMedGoogle Scholar
  2. 2.
    Da Costa L, Wallace C, ter Brugge KG et al (2009) The natural history and predictive features of hemorrhage from brain arteriovenous malformations. Stroke 40:100–105CrossRefPubMedGoogle Scholar
  3. 3.
    Fleetwood IG, Steinberg GK (2002) Arteriovenous malformations. Lancet 359:863–873CrossRefPubMedGoogle Scholar
  4. 4.
    Gross BA, Du R (2013) Natural history of cerebral arteriovenous malformations: a meta-analysis. J Neurosurg 118:437–443CrossRefPubMedGoogle Scholar
  5. 5.
    Hernisniemi J, Dashti R, Juvela S, Vaart K, Niemela M, Laasko A (2008) Natural history of brain arteriovenous malformations: a long term follow up study of risk of hemorrhage in 238 patients. Neurosurgery 63:823–829CrossRefGoogle Scholar
  6. 6.
    Laasko A, Dashti R, Juvela S, Isarakul P, Niemela M, Hernisniemi J (2011) Risk of hemorrhage in patients with untreated Spetzler Martin grade IV and V arteriovenous malformations: a long term follow up study in 63 patients. Neurosurgery 68:372–377CrossRefGoogle Scholar
  7. 7.
    Laasko A, Dashti R, Seppanen J, Juvela S, Vaart K, Niemela M, Sankila R, Hernisniemi J (2008) Long term excess mortality in 623 patients with brain arteriovenous malformations. Neurosurgery 63:244–253CrossRefGoogle Scholar
  8. 8.
    Ledezma CJ, Hoh BL, Carter BS, Pyror JC, Putman CM, Ogilvy CS (2006) Complications of cerebral arteriovenous malformation embolisation: multivariate analysis of predictive factors. Neurosurgery 58:602–611CrossRefPubMedGoogle Scholar
  9. 9.
    Lv X, Wu Z, Jiang C et al (2011) Angioarchitectural characteristics of brain arteriovenous malformations with and without hemorrhage. World Neurosurg 76:95–99CrossRefPubMedGoogle Scholar
  10. 10.
    Mehling T, Proust F, Gruber A, Niemela M, Regli L, Roche PH, Vajkoczy P (2014) On apples, oranges, and ARUBA. Acta Neurochirurgica (2014) 156:1775–1779Google Scholar
  11. 11.
    Mohr JP, Parides MK, Stapf C et al (2014) Medical management with or without interventional therapy for unruptured brain arteriovenous malformations [ARUBA]: a multicenter non-blinded, randomized trial. Lancet 383:614–621CrossRefPubMedGoogle Scholar
  12. 12.
    Pollock BE, Link MJ, Brown RD (2013) The risk of stroke or clinical impairment after stereotactic radiosurgery for ARUBA eligible patients. Stroke 44:437–441CrossRefPubMedGoogle Scholar
  13. 13.
    Potts MB, Lau D, Abla AA, Kim H, Young WL, Lawton MT (2015) Current surgical results with low grade brain arteriovenous malformations. J Neurosurg (2015) 122:912–920. [Epub ahead of print]Google Scholar
  14. 14.
    Salman RAS, White PM, Counsell CE et al (2014) Outcome after conservative management or intervention for unruptured brain arteriovenous malformations. JAMA 311:1661–1669CrossRefGoogle Scholar
  15. 15.
    Spetzler RF, Martin NA (1986) A proposed grading system für arteriovenous malformations. J Neurosurg 65:476–483CrossRefPubMedGoogle Scholar
  16. 16.
    Spetzler RF, Martin NA, Carter P et al (1987) Surgical management of large AVM’s by staged embolisation and operative excision. J Neurosurg 67:17–28CrossRefPubMedGoogle Scholar
  17. 17.
    Spetzler RF, Ponce FA (2011) A 3-tier classification of cerebral arteriovenous malformations. J Neurosurg 114:842–849CrossRefPubMedGoogle Scholar
  18. 18.
    Stapf C, Mast H, Sciacca RR et al (2006) Predictors of hemorrhage in patients with untreated brain arteriovenous malformations. Neurology 66:1350–1355CrossRefPubMedGoogle Scholar
  19. 19.
    Starke RM, Komotar RJ, Otten ML et al (2009) Adjuvant embolisation with N-butyl-cyanoacrylate in the treatment of cerebral arteriovenous malformations: outcomes, complications, and predictors of neurologic deficits. Stroke 40:2783–2790CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Van Beijnum J, van der Worp HB, Buis DR et al (2011) Treatment of brain arteriovenous malformations: a systematic review and meta-analysis. JAMA 306:2011–2019CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Andreas Gruber
    • 1
  • Gerhard Bavinzski
    • 1
  • Klaus Kitz
    • 1
  • Stephan Barthelmes
    • 1
  • Magdalena Mayr
    • 1
  • Engelbert Knosp
    • 1
  1. 1.Department of NeurosurgeryMedical University ViennaViennaAustria

Personalised recommendations