Transvenous Approach to Intracranial Arteriovenous Malformations: Challenging the Axioms of Arteriovenous Malformation Therapy?

Document Type

Article

Abstract

A compartmental conceptualization of intracranial arteriovenous malformations (AVMs) allows recognition of feeding arteries, an intervening plexiform nidus, and draining veins. AVM therapy involves eliminating the nidus, which is the source of hemorrhage, without compromising normal arterial and venous drainage of the brain. Traditional methods of AVM therapy through microsurgery and endovascular embolization involve arterial devascularization, with preservation of AVM venous drainage, until the nidus is excluded. The transvenous approach in treating vascular malformations was popularized by successful treatment models for dural arteriovenous fistulas. More recently, high-flow intracranial AVMs are being managed with transvenous endovascular approaches, although this novel technique has its challenges and perils. We review the current literature on transvenous AVM therapy and highlight its role for AVM therapy in the present day. ABBREVIATIONS: AVM, arteriovenous malformations DAVF, dural arteriovenous fistula TRENSH, transvenous retrograde nidus sclerotherapy under controlled hypotension VOG, vein of Galen .

Publication Date

1-1-2015

Publication Title

Neurosurgery

ISSN

0148396X

E-ISSN

15244040

Volume

77

Issue

4

First Page

644

Last Page

651

PubMed ID

26120797

Digital Object Identifier (DOI)

10.1227/NEU.0000000000000869

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