Curative Embolization of Arteriovenous Malformations

Arteriovenous malformations have a significant cumulative risk for hemorrhage. Treatment options include observation, microsurgical resection, stereotactic radiosurgery, embolization, and multimodal treatment. Treatment selection and timing are based on arteriovenous malformation (AVM) features including size, location in eloquent versus noneloquent parenchyma, pattern of venous drainage, surgical access, rupture status, and previous treatments. Spetzler-Martin grading is the most commonly used classification system used to select treatment, with grades I and II lesions amenable to surgical resection alone, grade III lesions typically treated via a multimodal approach entailing preoperative embolization followed by microsurgical resection, and grades IV and V lesions generally observed unless ruptured. Embolization in the treatment of AVMs is thus most commonly used as a preoperative or, occasionally, preradiosurgical adjunct. The concept of curative AVM embolization is an attractive one that has emerged within the past few decades, with increasing clinical evidence for its safety and efficacy in recent years. Obliteration rates for curative AVM embolization will be improved by innovation in endovascular techniques and technologies.