Current Concepts and Perspectives on Brain Arteriovenous Malformations: A Review of Pathogenesis and Multidisciplinary Treatment

Abstract

Brain arteriovenous malformations (bAVMs) are unusual vascular pathologies characterized by the abnormal aggregation of dilated arteries and veins in the brain parenchyma and for which the absence of a normal vascular structure and capillary bed leads to direct connections between the arteries and veins. Although bAVMs have long been believed to be congenital anomalies that develop during the prenatal period, more recent studies have shown that inflammation is associated with AVM genesis, growth, and rupture. The interventional treatment options include microsurgery, stereotactic radiosurgery, and endovascular embolization, and management often comprises a multidisciplinary combination of these modalities. The appropriate selection of patients with bAVMs for interventional treatment requires balancing the risk of treatment complications against the risk of hemorrhage during the natural course of the pathology. However, no definitive guidelines have been established for the management of bAVMs. We have comprehensively reviewed the current basic and clinical studies of bAVMs and discussed the contemporary status of multidisciplinary management of bAVMs.