Malformations

Intracranial arteriovenous malformations remain some of the most challenging lesions to treat by endovascular therapy. They may present with any number of symptoms, including seizures, headache, progressive neurological deficit or intracranial hemorrhage. They are increasingly being detected, particularly on MRI, as an incidental finding when the patient is being scanned for some unrelated reason.

Treatment of AVMs should always be multi-disciplinary, with input from the neuroradiolo-gist, neurosurgeon and the radiotherapist. Treatment can consist of embolization, surgery or stereotactic radiosurgery, or a combination of embolization followed by surgery or radiotherapy [24]. The goal of treatment is complete cure. Each patient is different. Factors to take into consideration include age, site (is the AVM in an eloquent area?), size, number of feeding arteries and presenting symptoms. It must never be forgotten that conservative treatment is always an option, particularly for elderly patients and for some large AVMs in eloquent areas.

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