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

Updated: Apr 21, 2022
  • Author: Glenn A Gonzalez, MD; Chief Editor: Brian H Kopell, MD  more...
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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.