Diagnosis and Treatment of Vascular Malformations of the Brain

Bradley A. Gross, Rose Du

Vascular malformations of the brain are often found in the workup of intracranial hemorrhage, seizures, focal neurological deficits, or headaches. Although CT-angiography may reveal an underlying arteriovenous malformation (AVM) or arteriovenous fistula (AVF), other vascular malformations are not easily evaluated on CT and are better seen on magnetic resonance imaging. For the evaluation of AVMs and AVFs, formal digital subtraction angiography remains the gold standard. In the case of AVMs, AVFs, or cavernous malformations (CMs), the lesion may serve as the etiologic source of the symptoms and thus warrant treatment. When feasible, microsurgical resection is the optimal treatment option for AVMs and CMs. Endovascular embolization may serve as a crucial adjunct to microsurgery in the treatment of AVMs. Depending on their vascular anatomy, AVFs may be treated by either endovascular embolization or microsurgery. For inoperable AVMs and dural AVFs necessitating treatment, stereotactic radiosurgery (SRS) may serve as a viable treatment alternative. Capillary telangiectasias and developmental venous anomalies (DVAs) are often incidental findings; they may be found in association with CMs but are not generally considered targets for treatment. Herein, we review diagnostic methods, natural history, and treatment options for these cerebral vascular malformations.