Brain AVM Embolization

Although cerebral vascular malformations had long been known in the literature, William McCormick is credited with developing the first comprehensive pathological classification method for these lesions in the 1960s. Capillary telangiectasia, developmental venous abnormality, cavernous malformation, and arteriovenous malformation are all named after him in modern literature. Arteriovenous fistulae and mixed vascular malformations are also included in certain schemes for completeness. 

Cerebral AVMs are complicated lesions made up of a network of aberrant arteries and veins with no intervening capillary bed, leading to high AV shunting. AVMs are congenital and most typically occur sporadically, despite the fact that familial cases have been reported. Various investigations have discovered a link between inherited hemorrhagic telangiectasia, Sturge-Weber syndrome, and Wyburn-Mason syndrome. Intracranial bleeding is a common symptom of AVMs, but seizures, headaches, and localized neurological impairments can also occur. A yearly hemorrhage risk of 3% to 4% is frequently reported, with a 6 to 25 percent chance of death and a 10 to 50 percent risk of neurological impairment. The Spetzler-Martin grading system, which provides points for AVM size, position, and venous drainage pattern, was originally designed as a surgical risk assessment tool. It is now routinely used to define AVMs in the clinical environment.

Microsurgical resection, endovascular embolization, and stereotactic radiosurgery are some of the current therapy options for cerebral AVMs. While any of these modalities can be utilized on its own, a combination is frequently required to achieve the optimum therapy results. It might be difficult to decide what form of intervention to provide or whether intervention should be provided at all. Finally, a risk-benefit assessment should be undertaken, taking into account the AVM's natural history as well as the hazards associated with the planned therapies. Recent data imply that medical care may be better than interventional therapy for unruptured AVMs, at least in the near term, emphasizing the need for such research. For properly managing AVMs, establishing a multidisciplinary team with competence in medical, surgical, endovascular, and radiation treatment is crucial.

The interdisciplinary management of all AVMs should include endovascular expertise. Even if conservative care is anticipated, all AVMs should be defined by a catheter cerebral angiography, with rare exceptions. The presence of concomitant aneurysms or venous outflow blockage, as well as the number and location of supplying vessels and draining veins, are all important factors to consider when making a selection. Pre-microsurgical embolization, pre-radiosurgical embolization, curative embolization, and palliative embolization are all options if endovascular intervention is chosen.