Zur Therapie zerebraler arteriovenöser Malformationen

Zusammenfassung

Die therapeutischen Optionen für zerebrale arteriovenöse Malformationen (AVM) haben sich durch die fortschreitende Entwicklung mikrochirurgischer, endovaskulärer und strahlentherapeutischer Verfahren deutlich erweitert. Gleichzeitig ist jedoch auch die Wahl des geeigneten therapeutischen Vorgehens schwieriger geworden. Die gegenwärtigen Behandlungsentscheidungen werden sowohl durch einen Mangel an Daten zur Komplikationsrate invasiver Therapien, als auch die zu geringen Kenntnisse über den Spontanverlauf und das Blutungsrisiko von AVM beeinträchtigt.

Summary

The rapid development of modern endovascular, microsurgical, and radiation therapies has considerably expanded the treatment options for encephalic arteriovenous malformations (AVMs). Surgery has the longest history. Single or staged intravascular procedures (embolizations) using fast-acting glues, sclerotic agents, and thrombogenic coils serve to reduce the size of AVM to that suitable for extirpation and may reduce the risk of surgery. Radiation (”gamma-knife”) therapy, most frequently used in small, non-operable AVMs, is also viewed by some authors as an alternative or even superior tool in small, operable malformations. Partial embolization to reduce the mass-effect of space-occupying AVMs, to reverse diaschisis, and to treat AVM-related seizure disorders is being discussed and practiced. Given the in part competing or even controversial options, the selection of optimal treatment for AVM patients is becoming increasingly difficult. Current management is impeded by the paucity of information on the exact risks of invasive therapies and by insufficient criteria for identifying patients at risk of spontaneous bleeding during the natural course, including the seriousness of such hemorrhage.