Guidelines Summary

The Society of NeuroInterventional Surgery (SNIS) has produced the following guidelines for management of brain AVMs^[33]:

Digital subtraction catheter cerebral angiography (DSA), including 2D, 3D, and reformatted cross-sectional views when appropriate, is recommended in the pretreatment assessment of cerebral AVMs.
It is recommended that endovascular embolization of cerebral AVMs be performed in the context of a complete multidisciplinary treatment plan aiming for obliteration of the AVM and cure.
Embolization of brain AVMs before surgical resection can be useful to reduce intraoperative blood loss, morbidity, and surgical complexity.
The role of primary curative embolization of cerebral AVMs is uncertain, particularly as compared with microsurgery and radiosurgery with or without adjunctive embolization. Further research is needed, particularly with regard to risk for AVM recurrence.
Targeted embolization of high-risk features of ruptured brain AVMs may be considered to reduce the risk for recurrent hemorrhage.
Palliative embolization may be useful to treat symptomatic AVMs in which curative therapy is otherwise not possible.
The role of AVM embolization as an adjunct to radiosurgery is not well-established. Further research is needed.
Imaging follow-up after apparent cure of brain AVMs is recommended to assess for recurrence. Although noninvasive imaging may be used for longitudinal follow-up, DSA remains the gold standard for residual or recurrent AVM detection in patients with concerning imaging and/or clinical findings.

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Media Gallery

Spinal malformation. This is a sagittal T2-weighted MRI of the thoracic spine of a 68-year-old woman with a 9-month history of back pain and sensory loss, progressing to the point of loss of bowel and bladder function along with a sudden onset of paraparesis. Note the thoracolumbar junction with an edematous spinal cord and dilated serpiginous intradural venous plexus.
Spinal malformation. This is an axial T2-weighted MRI of the thoracic spine of a 68-year-old woman with a 9-month history of back pain and sensory loss, progressing to the point of loss of bowel and bladder function along with a sudden onset of paraparesis. Note the lumbar spine with an edematous spinal cord and dilated intradural venous plexus.

of 2

Author

Glenn A Gonzalez, MD Post-Doctoral Research Fellow, Department of Neurosurgery, Sidney Kimmel Medical College of Thomas Jefferson University

Disclosure: Nothing to disclose.

Coauthor(s)

Tristan Blase Fried, MD Resident Physician, Department of Orthopedic Surgery, Thomas Jefferson Hospital

Disclosure: Nothing to disclose.

Corey E Cheresnick Jefferson Medical College of Thomas Jefferson University

Disclosure: Nothing to disclose.

George M Ghobrial, MD Resident Physician, Department of Neurological Surgery, Thomas Jefferson University Hospital

Disclosure: Nothing to disclose.

Aaron S Dumont, MD Charles B Wilson Professor and Chairman, Department of Neurological Surgery, Tulane University School of Medicine

Aaron S Dumont, MD is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, North American Skull Base Society, Society of NeuroInterventional Surgery, Neurocritical Care Society

Disclosure: Nothing to disclose.

James W Pritchett, MD Chief of Orthopedic Surgery, Swedish Orthopedic Institute; Active Staff, Swedish Medical Center

James W Pritchett, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, Washington State Medical Association, Association of Bone and Joint Surgeons

Disclosure: Nothing to disclose.

James S Harrop, MD Associate Professor, Departments of Neurological and Orthopedic Surgery, Jefferson Medical College of Thomas Jefferson University

James S Harrop, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Spinal Injury Association, Cervical Spine Research Society, Congress of Neurological Surgeons, North American Spine Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Depuy spine consulant, Asterias, Bioventus, Tejin serve on advisory boards<br/>Received research grant from: DOD, PICORI<br/>Received income in an amount equal to or greater than $250 from: Stryker honorarium.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, Congress of Neurological Surgeons, International Parkinson and Movement Disorder Society, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from Abbott Neuromodulation for consulting; Received Consulting Fee from ClearPoint Neuro.

Additional Contributors

Paul L Penar, MD, FACS Professor, Department of Surgery, Division of Neurosurgery, Director, Functional Neurosurgery and Radiosurgery Programs, University of Vermont College of Medicine

Paul L Penar, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, World Society for Stereotactic and Functional Neurosurgery, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

Pascal M Jabbour, MD Cerebrovascular Fellowship, Department of Neurosurgery, Thomas Jefferson University Hospital

Pascal M Jabbour, MD is a member of the following medical societies: Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Jennifer Malone, RN Department of Neurosurgery, Jefferson Medical College

Disclosure: Nothing to disclose.

Gregory J Przybylski, MD Professor of Neurological Surgery, Seton Hall University, School of Graduate Medical Education; Director of Neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center

Disclosure: Nothing to disclose.

Sections Arteriovenous Malformations and Fistulas (AVM/AVF) of the Spinal Cord
Overview
Workup
Treatment
Guidelines
Media Gallery
References

Arteriovenous Malformations and Fistulas (AVM/AVF) of the Spinal Cord Guidelines

Guidelines Summary

References

Tables

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