Malformazioni artero-venose del sistema nervoso centrale: Fisiopatologia e strategia di trattamento

Translated title of the contribution: Central nervous system arteriovenous malformations: Physiopathology and treatment strategies

A. Andreoli, L. Simonetti, C. Sturiale, R. Agati, M. Leonardi

Research output: Contribution to journalArticlepeer-review

Abstract

Three treatment options or a combination of the three are currently available in the management of arteriovenous malformations (AVM): microsurgery, embolisation and radiosurgery. Choosing the most appropriate treatment strategy is not always simple and must be tailored to each individual case on the basis of clinical, epidemiological and neuroradiological findings. The diagnostic work-up for AVMs includes many investigations: CT and/or angio-CT, MR, angio-MR and activation functional MR (MR-f), angiography and other functional examinations such as PET, evoked potentials (children under general anaesthesia or rolandic AVM) or transcranial Doppler. The choice of technique will depend on what information is required. If traditional surgery is the main treatment option based on grading the AVM according to Spetzler and Martin's system, the information provided by CT/angio-CT or MR/angio-MR is sufficient. The limitations of this approach are well-known and the grading system is of little use in assessing the risk of endovascular or radiosurgical treatment. For this reason, selective and superselective angiography is more appropriate for in-depth study of AVM angioarchitecture and physiopathology. It is important to analyse all the components of the angiogram: arterial afferents, nidus and venous drainage. At the end of the work-up, the sum of the physiopathological information will determine the treatment of choice: surgery, radiosurgery, endovascular treatment, various combinations or conservative management. In some patients, any of the treatment strategies would be effective and in these cases surgery is preferable as it is anatomically resolutive. In others, the clinical features or instrumental tests warrant only one type of treatment: surgery, radiosurgery or embolisation. In still others, management combining two or more treatments in succession is the option most likely to yield the best outcome. Lastly, in some patients, the risk of any type of treatment is greater than the risk of the natural history of the disease and in these cases conservative management is the best treatment option.

Translated title of the contributionCentral nervous system arteriovenous malformations: Physiopathology and treatment strategies
Original languageItalian
Pages (from-to)55-67
Number of pages13
JournalRivista di Neuroradiologia
Volume15
Issue number1
Publication statusPublished - 2002

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

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