Transvenous Approach to Intracranial Arteriovenous Malformations: Challenging the Axioms of Arteriovenous Malformation Therapy?

Omar Choudhri, Michael E. Ivan, Michael T. Lawton

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

A compartmental conceptualization of intracranial arteriovenous malformations (AVMs) allows recognition of feeding arteries, an intervening plexiform nidus, and draining veins. AVM therapy involves eliminating the nidus, which is the source of hemorrhage, without compromising normal arterial and venous drainage of the brain. Traditional methods of AVM therapy through microsurgery and endovascular embolization involve arterial devascularization, with preservation of AVM venous drainage, until the nidus is excluded. The transvenous approach in treating vascular malformations was popularized by successful treatment models for dural arteriovenous fistulas. More recently, high-flow intracranial AVMs are being managed with transvenous endovascular approaches, although this novel technique has its challenges and perils. We review the current literature on transvenous AVM therapy and highlight its role for AVM therapy in the present day. ABBREVIATIONS: AVM, arteriovenous malformations DAVF, dural arteriovenous fistula TRENSH, transvenous retrograde nidus sclerotherapy under controlled hypotension VOG, vein of Galen .

Original languageEnglish (US)
Pages (from-to)644-651
Number of pages8
JournalNeurosurgery
Volume77
Issue number4
DOIs
StatePublished - Oct 21 2015
Externally publishedYes

Keywords

  • KEY WORDS: Intracranial arteriovenous malformations
  • Transvenous approach
  • Vascular malformations

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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