Arteriovenous Malformations of the Brain

In this second of a two-part article, the treatment of arteriovenous malformations (AVMs) of the brain is discussed. The natural course of these lesions, which is treacherous, must be balanced against the risk-effectiveness of various therapies. Radiotherapy rarely abolishes these lesions and subjects the patient to the risk of radionecrosis and rebleed from the AVM. Embolization, which involves the placement of small spheres into the lesion under radiographic control, is a moderately safe procedure that can reduce the size of, but rarely eliminates, these malformations. Embolization, however, has been used effectively in preparing the lesion for excision. The techniques of contemporary surgery and the results of treatment of a large number of AVMs are discussed.