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Management of Brain Arteriovenous Malformations

  • Critical Care Neurology (K Sheth, Section Editor)
  • Published:
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Opinion statement

Arteriovenous malformations (AVMs) pose a risk of morbidity and mortality throughout an affected patient’s lifetime. Over the course of a patient’s life, the risk of hemorrhage is approximately 1–4 % per year, and after an initial hemorrhage occurs, this risk may be higher. Other causes of morbidity include seizures, headaches, or progressive neurologic deficits. Once an AVM has been discovered, the utility of attempted obliteration or surgical resection compared to the risk of intervention should be entertained. The characteristics of the malformation as well as the patient’s overall health status contribute to the decision to intervene on these lesions. For small lesions located in superficial areas without high-risk surgical characteristics (low-grade Spetzler-Martin grades), it is reasonable to consider surgical resection. In lesions that pose high-risk of complications from surgical removal, intra-arterial embolization, radiosurgery, or a combination of the two may be reasonable treatment options. Some AVMs at traditional high surgical risk may be amenable to partial embolization, allowing initially high-risk lesions to become better candidates for surgical resection. In some patients, particularly those who are older or who have multiple medical comorbidities, the risk of intervention as compared to the annual hemorrhage risk may warrant conservative management as opposed to intervention. The overall treatment strategy must be based on patient and AVM characteristics and careful risk-benefit ratio analysis.

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Conflict of Interest

Sherri A. Braksick and Jennifer E. Fugate declare no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by the authors.

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  1. Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Sherri A. Braksick MD & Jennifer E. Fugate DO

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  1. Sherri A. Braksick MD
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  2. Jennifer E. Fugate DO
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Correspondence to Jennifer E. Fugate DO.

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This article is part of the Topical Collection on Critical Care Neurology

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Braksick, S.A., Fugate, J.E. Management of Brain Arteriovenous Malformations. Curr Treat Options Neurol 17, 32 (2015). https://doi.org/10.1007/s11940-015-0358-1

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