The Role of Embolisation in the Management of Arteriovenous Malformations

Abstract

Arteriovenous malformations in the brain are congenital lesions that present with haemorrhages, seizures, headaches and neurological deficits.  The clinical presentation of AVM are haemorrhages, seizures, headaches sometimes in the form of migraines and neurological deficit5 as a result of injury to the surrounding eloquent brain regions.8 In some instances AVMs are asymptomatic. AVMs usually only present themselves in the second or third decade of life and occurs with equal frequency in both men and women.⁵

The natural history of AVMs are haemorrhages, seizures, neurological deficits, headaches and death.  

Endovascular embolisation is often used to treat small AVMs and is minimally invasive. It can be used prior to both surgery and radio-surgery. Embolisation alone cannot obliterate many morphologically different groups of AVMs. It is normally only used to obliterate smaller AVMs with limited number of feeders.  

Nevertheless, embolisation has emerged as a part of multi-modality treatment in the overall management in certain parts of the world. The success of any particular approach depends on a multi-disciplinary team comprising of surgeons and interventional specialists.