Additional references for: Brain arteriovenous malformations: a review of natural history, pathobiology, and interventions

Brain arteriovenous malformations (AVMs) are anomalous direct
shunts between cerebral arteries and veins that convalesce into a vascular
nidus. The treatment strategies for AVMs are challenging and variable.
Intracranial hemorrhage and seizures comprise the most common
presentations of AVMs. However, incidental AVMs are being diagnosed with
increasing frequency due to widespread use of noninvasive neuroimaging.
The balance between the estimated cumulative lifetime hemorrhage risk
versus the risk of intervention is often the major determinant for
treatment. Current management options include surgical resection,
embolization, stereotactic radiosurgery (SRS), and observation. Complete
nidal obliteration is the goal of AVM intervention. The risks and benefits
of interventions vary and can be employed in a combinatorial fashion.
Resection of the AVM nidus affords high rates of immediate obliteration,
but it is invasive and carries a moderate risk of neurological morbidity.
AVM embolization is minimally invasive, but cure can only be achieved in a
minority of lesions. SRS is also minimally invasive and has little
immediate morbidity, but AVM obliteration occurs in a delayed fashion, so
the patient remains at risk for hemorrhage during the latency period.
Whether obliteration can be achieved in unruptured AVMs with a lower risk
of stroke or death compared to the natural history of AVMs remains
controversial. Over the past 5 years, multicenter prospective and
retrospective studies describing AVM natural history and treatment
outcomes have been published. This review provides a contemporary and
comprehensive discussion of the natural history, pathobiology, and
interventions for brain AVMs.