Congenital pial AVF are caused by a missed step in vascular development during the early embryonic stage. Transarterial endovascular embolizaiton using NBCA with or without using coils to attain flow control is the treatment of choice, with low morbidity. The efficacy of treatment is high as demonstrated by the high cure rate. Follow-up angiogram is mandatory to look for recanalization, reactive angiogenesis and denovo dural AVF development.

Compared with drip-and-ship, the trip-and-treat model demonstrated shorter treatment times for endovascular therapy in our series. The trip-and-treat model offers a valid alternative to current interhospital stroke transfers in urban environments.

Technical and technological advancements in endovascular embolization along with better understanding of clinical, anatomic, and pathophysiological aspects have resulted in significantly improved outcome and prognosis in VGAM. Most patients with proper treatment can now survive and most develop normally following appropriately timed treatment.

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A multidisciplinary approach to airway vascular malformations with a combination of endoscopy and direct puncture bleomycin sclerotherapy was demonstrated to be a safe and effective treatment in our patient cohort. Direct laryngoscopy and nasopharyngoscopy provide easy access to the nasopharynx, oropharynx, retro- and/or parapharyngeal spaces and larynx. Unlike traditional agents, bleomycin induces minimal edema and therefore is an ideal substance to treat airway lesions.

Iatrogenic dissection is a random event with a benign clinical course. Early detection and aggressive management result in excellent outcome. Angiography is the best modality to follow-up. Non-invasive imaging like MRI with MRA and duplex ultrasonography are good tools to follow dissections.

Dilated SOV is a rare radiographic finding resulting from a wide spectrum of etiologies with clinical implications ranging from benign to sight- and life-threatening. Dilated SOV is most often found with dural-cavernous fistula or carotid-cavernous fistula, orbital or facial arteriovenous malformation, and venous thrombosis. Recognition of this finding and management of the underlying condition is critical.

Aspiration success was associated with younger age. Our findings suggest that ADAPT can be used for the vast majority of patients but it may be beneficial to use a different method first in the elderly.