Hemodynamics Associated With Intracerebral Arteriovenous Malformations: The Effects of Treatment Modalities

Abstract

The understanding of the physiology of cerebral arteriovenous malformations (AVMs) continues to expand. Knowledge of the hemodynamics of blood flow associated with AVMs is also progressing as imaging and treatment modalities advance. The authors present a comprehensive literature review that reveals the physical hemodynamics of AVMs, and the effect that various treatment modalities have on AVM hemodynamics and the surrounding cortex and vasculature. The authors discuss feeding arteries, flow through the nidus, venous outflow, and the relative effects of radiosurgical monotherapy, endovascular embolization alone, and combined microsurgical treatments. The hemodynamics associated with intracranial AVMs is complex and likely changes over time with changes in the physical morphology and angioarchitecture of the lesions. Hemodynamic change may be even more of a factor as it pertains to the vast array of single and multimodal treatment options available. An understanding of AVM hemodynamics associated with differing treatment modalities can affect treatment strategies and should be considered for optimal clinical outcomes.

Risk factors for hemorrhage of brain arteriovenous malformation

“…More flow metrics might improve identification of patients at risk. Alternatively, we also have uncertainty of posttherapeutic ICH, such as after microsurgical, embolization, or gamma knife treatments . Demonstrating flow parameters preintervention that elevate posttreatment risk could help direct patients to alternative therapies and/or different postsurgical management .…”

“…Alternatively, we also have uncertainty of posttherapeutic ICH, such as after microsurgical, embolization, or gamma knife treatments. 68 Demonstrating flow parameters preintervention that elevate posttreatment risk could help direct patients to alternative therapies and/or different postsurgical management. [69][70][71][72][73] Research into both of these clinical scenarios has enlisted hemodynamic metrics to help explain such hemorrhagic episodes with varying degrees of success.…”

Arteriovenous malformation presenting with epilepsy: a multimodal approach to diagnosis and treatment

“…29 The second most common presentation of AVM is seizures, which occur in 20%-45% of patients. 16,29 The mechanism of seizure in AVM is multifold, including those seizures directly due to hemorrhage and hemosiderosis, as well as seizures secondary to vascular steal, perinidal edema, and nidus size and location. 16,17,29,55 Patient factors including male sex and age younger than 65 years have also been associated with seizure onset.…”

“…16,29 The mechanism of seizure in AVM is multifold, including those seizures directly due to hemorrhage and hemosiderosis, as well as seizures secondary to vascular steal, perinidal edema, and nidus size and location. 16,17,29,55 Patient factors including male sex and age younger than 65 years have also been associated with seizure onset. 22 In those who present with seizure, at least half of patients with AVM will experience seizure recurrence within 5 years of a first-ever seizure event.…”

“…18 Despite this working definition, patient outcomes vary depending on if they present with a first-ever seizure or with chronic or drug-resistant epilepsy (DRE). 16 In this review the authors provide an overview of AVMrelated epilepsy characterization and treatment, emphasiz-ing new technological advances in AVM-related epilepsy diagnostics. In addition, the findings of studies exploring single or combined embolization, radiosurgical, or microsurgical approaches are discussed in the context of seizure freedom.…”