Partial "targeted" embolisation of brain arteriovenous malformations.
The treatment of pial arteriovenous brain malformations is controversial. Little is yet known about their natural history, their pathomechanisms and the efficacy and risks of respective proposed treatments. It is known that only complete occlusion of the AVM can exclude future risk of haemorrhage and that the rates of curative embolisation of AVMs with an acceptable periprocedural risk are around 20 to 50%. As outlined in the present article, however, partial, targeted embolisation also plays a role. In acutely ruptured AVMs where the source of bleeding can be identified, targeted embolisation of this compartment may be able to secure the AVM prior to definitive treatment. In unruptured symptomatic AVMs targeted treatment may be employed if a defined pathomechanism can be identified that is related to the clinical symptoms and that can be cured with an acceptable risk via an endovascular approach depending on the individual AVM angioarchitecture. This review article gives examples of pathomechanisms and angioarchitectures that are amenable to this kind of treatment strategy.
Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, UHN, 399 Bathurst St., 3MCL-429, Toronto, ON M5T 2S8, Canada. timo.krings@uhn.on.ca
Timo
T
Krings
Franz-Josef
FJ
Hans
Sasikhan
S
Geibprasert
Karel
K
Terbrugge
D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*