Cranial Arteriovenous Malformations (AVMs) and Cranial Dural Arteriovenous Fistulas (DAVFs), An Issue of Neurosurgery Clinics (The Clinics: Surgery) (Original PDF from Publisher)

Cranial Arteriovenous Lesions: A Comprehensive Review

Guest editors Rafael J. Tamargo and Judy Huang delve into the intricacies of cranial arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) in this issue of Neurosurgery Clinics of North America. This comprehensive compendium offers an in-depth exploration of these complex conditions, encompassing their epidemiology, clinical manifestations, and management strategies.

Arteriovenous Malformations and Dural Arteriovenous Fistulas

Epidemiology and Clinical Presentation:

• Delve into the prevalence, geographic distribution, and risk factors associated with AVMs and DAVFs.
• Explore the diverse clinical presentations of these lesions, ranging from asymptomatic to life-threatening hemorrhage.

Historical Treatment Landscape:

• Trace the evolution of treatment approaches for AVMs and DAVFs, highlighting the milestones and controversies that have shaped their management.

Imaging Techniques:

• Gain insights into the various imaging modalities employed to diagnose and characterize AVMs and DAVFs, including angiography, MRI, and CT scans.
• Understand the role of advanced imaging techniques, such as perfusion-weighted imaging and diffusion tensor imaging, in refining diagnosis and treatment planning.

Classification Schemes

Arteriovenous Malformations:

• Familiarize yourself with the Spetzler-Martin grade, which classifies AVMs based on size, location, and venous drainage patterns.
• Explore other classification systems, such as the Borden scale and the Lawton-Young classification, and their utility in guiding treatment decisions.

Dural Arteriovenous Fistulas:

• Learn about the Cognard classification system, which categorizes DAVFs based on their anatomic location and venous drainage patterns.
• Understand the implications of DAVF classification for treatment selection and outcomes.

Management Considerations

Acute Management of Ruptured AVMs and DAVFs:

• Explore the principles of emergent care for patients with ruptured cranial arteriovenous lesions.
• Discuss the role of embolization, surgical intervention, and medical management in stabilizing these critically ill patients.

Treatment Modality Selection

Arteriovenous Malformations:

• Weigh the pros and cons of surgical resection, stereotactic radiosurgery (SRS), and endovascular embolization in the treatment of AVMs.
• Consider the influence of patient age, AVM location, and comorbidities on treatment decisions.

Dural Arteriovenous Malformations:

• Discuss the spectrum of treatment options for DAVFs, including endovascular embolization, SRS, and surgical intervention.
• Explore the factors that drive treatment selection and influence outcomes.

Surgical Management Techniques

AVMs and DAVFs:

• Examine the surgical approaches employed in the treatment of cranial arteriovenous lesions.
• Discuss the principles of microsurgery, vascular reconstruction, and skull base surgery in the management of these complex entities.

Intraoperative Monitoring and Anesthesia

• Understand the importance of intraoperative monitoring during surgery for AVMs and DAVFs.
• Explore the techniques used to monitor cerebral blood flow, hemodynamics, and neurologic function.
• Discuss the role of anesthesia in optimizing patient outcomes during surgery.

Endovascular Treatment Options

• Delve into the endovascular techniques used to treat AVMs and DAVFs.
• Explore embolic agents, stents, and balloons and their applications in occluding and redirecting abnormal vascular flow.

Adjunctive Therapies

Occlusive Hyperemia:

• Understand the concept of occlusive hyperemia and its implications for post-treatment management of cranial arteriovenous lesions.
• Discuss techniques to minimize the risk of hyperemia and ensure optimal patient outcomes.

Rare Cranial Arteriovenous Anomalies

Vein of Galen Malformations:

• Explore the unique epidemiology, clinical presentation, and management challenges associated with vein of Galen malformations.
• Discuss multidisciplinary approaches to treating these complex lesions.

Carotid Cavernous Fistulas:

• Gain insights into the epidemiology, clinical manifestations, and management strategies for carotid cavernous fistulas.
• Discuss the role of endovascular embolization, SRS, and surgical intervention in the treatment of this rare but potentially devastating condition.