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VII. Treatment

Treatment aimed at preventing hemorrhage, controlling seizures and reversing any progressive neurological deficit, in order to increase survival with the least morbidity possible. In most cases, this is possible by means of complete excision of the lesion. Although this may not always be the best option for the patient depending : on his/her overall condition, on the AVM Spetzler-Martin grade, and on the experience of the treatment team (neurosurgeon, neuroradiologist or radiosurgeon). Thus the risks of conservative versus invasive treatments should be considered.

There are no randomized studies to guide such a decision, which means each case must be carefully analyzed by a multidisciplinary and experienced team. Partial treatment of AVMs has shown proven not to be not beneficial, and may result in an increase in the risk of hemorrhage, according to some studies. So when planning to treat an AVM the total resection should always be considered as the only option. Although there are some exceptions, and sometimes the partial treatment is very important :
 Cases of giant AVMs with risk factors such as intranidal aneurysms that can be treated with the occlusion of the aneurysms.
 Progressive neurological deficit secondary to high flow fistulas with steal flow symptoms that can be treated with the occlusion of the fistulas.
 Intractable headache that can be treated with occlusion of the meningeal arteries.

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