Endovascular management of cerebral arteriovenous malformations

Cerebral arteriovenous malformations (AVMs) may present as incidental findings on imaging studies in completely asymptomatic patients or be the cause of death in others who have suffered massive cerebral hemorrhages. Between those extremes, symptoms may include seizures, focal neurological deficits, headaches, and bruits. Cerebral AVMs may derive their blood supply from pial vessels or dural vessels, or both, and may drain into cortical veins, deep venous sinuses, orbital veins, and spinal veins. The goals of treatment are to eliminate the risk of bleeding and neurological deficits, seizures, and other related symptoms. Methods of treatment include surgical resection of the malformation, stereotaxic radiosurgery, antiseizure medication, embolization, and combinations of the above. Embolization methods include transarterial, transvenous, and direct delivery of embolic agents. Embolic materials include liquid adhesives, polymers, sclerosing agents, particles, coils, and balloons. This article discusses embolization goals, techniques, and complications in the treatment of cerebral AVMs.