Historical developments in the treatment of vascular malformation has been since 1762 by Hunter. Further, in 1851 Virchow and others developed a classification of telangiectasias, and of venous, arterial, arteriovenous, and cystic angiomas. The year of 1889, marked the successful excision of an intracranial AVM that was performed. Vascular malformations can be classified as Capillary telangiectasias, Cavernous malformations, Venous malformations, Arteriovenous malformations. The paper focuses on the Arteriovenous malformations (AVM). Mullan and colleagues hypothesized that AVMs begin during human embryonic development during the sequential formation and absorption of surface veins. In the absence of the middle cerebral vein or its failure
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In this procedure, with fluoroscopic guidance a catheter is inserted through femoral artery into the artery with AVM. Subsequently embolic materials, such as wire coils, pellets, particulate slurries, or glue, are injected in a controlled fashion to occlude the arterial supply of the AVM [68]. An embolization treatment cannot fully kill an AVM, thus, this technique cannot act as a solo treatment and needs to be combined with other technique. A partially treated AVM may be more likely to bleed than an untreated AVM; therefore endovascular treatment is not recommended unless utilized as part of a multimodality plan geared towards total obliteration of the malformation. Radiosurgey was first figured out by Cushing and Bailey for AVM patients. The principles of stereototactic radiosurgery are based upon delivering high-energy radiation to a well-defined volume containing the nidus of the malformation. Radiosurgery was first performed with a device called the gamma knife [77]. With proper dosimetry the immediate side-effects of radiosurgery have been moderate and limited to mild episodes of radiation necrosis [82]. The long-term side-effects of radiosurgery, as well as the risk of bleeding, have been studied by a number of different groups [83-86]. The research paper examines a case of a 33 year old woman with sudden headache and left sided hemiplegia. The patient had two stages of treatment, first with embolization following radiosurgery. A follow-up angiogram 3 years after treatment of the AVM with radiosurgery revealed complete obliteration of the AVM (Fig
In this procedure, with fluoroscopic guidance a catheter is inserted through femoral artery into the artery with AVM. Subsequently embolic materials, such as wire coils, pellets, particulate slurries, or glue, are injected in a controlled fashion to occlude the arterial supply of the AVM [68]. An embolization treatment cannot fully kill an AVM, thus, this technique cannot act as a solo treatment and needs to be combined with other technique. A partially treated AVM may be more likely to bleed than an untreated AVM; therefore endovascular treatment is not recommended unless utilized as part of a multimodality plan geared towards total obliteration of the malformation. Radiosurgey was first figured out by Cushing and Bailey for AVM patients. The principles of stereototactic radiosurgery are based upon delivering high-energy radiation to a well-defined volume containing the nidus of the malformation. Radiosurgery was first performed with a device called the gamma knife [77]. With proper dosimetry the immediate side-effects of radiosurgery have been moderate and limited to mild episodes of radiation necrosis [82]. The long-term side-effects of radiosurgery, as well as the risk of bleeding, have been studied by a number of different groups [83-86]. The research paper examines a case of a 33 year old woman with sudden headache and left sided hemiplegia. The patient had two stages of treatment, first with embolization following radiosurgery. A follow-up angiogram 3 years after treatment of the AVM with radiosurgery revealed complete obliteration of the AVM (Fig