Radiosurgery of Brain Arteriovenous and Cavernous Malformations
Brain arteriovenous malformations (bAVMs) consist of an abnormal tangle of vessels that shunts blood directly from an artery to a vein, without intervention of a capillary bed. The absence of a capillary bed results into an abnormal high pressure flow from the feeding artery or arteries into draining vein(s) and thus higher pressure on the venous side. bAVMs are rare vascular entities, with an incidence of approximately 1.3 per 100,000 person-years and a prevalence of 10–18 per 100,000 person-years. bAVMs are the most frequent cause of nontraumatic intracerebral hemorrhage (ICH) in people younger than 35 years. Other clinical manifestations are seizures, headaches and progressive neurological symptoms (8%) related to ischemia of the surrounding 122w2ssssewdsafgewrhytehtbrain tissue. The main treatment goal of bAVMs is the complete elimination or obliteration of the nidus and of the arteriovenous shunts. The first method is microsurgical resection, which can be performed primarily or following bAVM embolization to reduce the risk of bleeding during surgery and make the resection less challenging. The second method is endovascular embolization, which can be used as a complementary method to the previous techniques, however, in some specific circumstances could serve as definitive treatment and achieve complete obliteration of the bAVM. The third option is stereotactic radiosurgery (SRS), which can in line with microsurgery be applied primarily or after embolization. This chapter discuss the current data on classifications and management of bAVM or cavernous malformation patients.
KeywordsBrain AVMs Cavernous malformations Risk of rupture Microsurgery Stereotactic Radiosurgery
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