Principles of Neuroendovascular Management of AVMs: Goals, Timing, Techniques, and Outcomes

Intracranial AVMs (iAVMs) are among the most challenging and complex pathologies of the brain, often requiring a multimodality treatment approach. Endovascular techniques are practiced in four different settings, each with an associated goal: adjunctive (preoperative embolization to facilitate microsurgical resection or radiosurgery), curative (embolization attempted for cure), targeted therapy (to treat the source of bleeding), and palliative (embolization to reduce arteriovenous shunting). With recent advancements in endovascular techniques and transvenous embolization, many AVMs can be cured with endovascular techniques alone. N-butyl cyanoacrylate, Onyx (Medtronic), and coils are the most commonly used embolic agents, with precipitating hydrophobic injectable liquid gaining popularity. In this chapter, the authors discuss goals, timing, techniques, and outcomes of neuroendovascular management of iAVMs..