Therapeutic Management of Cerebral Arteriovenous Malformations. Present Role of Interventional Neuroradiology

Abstract

This chapter summarizes the authors' experience in the endovascular therapy of cerebral arteriovenous malformations (AVMs). This clinical series includes 660 patients treated from 1980 to 2005. The first 148 patients were treated at University Hospital, in London, Ontario Canada, in association with Drs. Allan Fox, Dave Pelz, John Girvin and Charles Drake. The next 512 patients were treated at UCLA Medical Center, Los Angeles, California in association with Drs. Gary Duckwiler, Reza Jahan, Jacques Dion, Pierre Gobin, Neil Martin and John Frazee. Only patients treated with superselective endovascular/intraoperative catheterization and embolization of avm arterial feeders were included. Cerebral arteriovenous malformations treated by non-selective injection of beads in ICA or vertebral arteries were excluded. Modern neuroimaging modalities associated to the anatomical, topographic and functional evaluations of cerebral avms such as brain CT and CTA, MRI, MRA and functional MRI are all utilized at UCLA Medical Center. They have become essential in the therapeutic management of avms closely related to cerebral eloquent areas (figure 1).