Background: Arteriovenous malformations (AVM) are rare intracranial pathological connections between arteries and veins with an intervening nidus. They are the leading cause to intracranial hemorrhage in young adults. Apart from hemorrhage, AVM can also cause epileptic seizures, headache and focal neurological deficits. However most of the AVMs are asymptomatic, but due to the development of cross-sectional brain imaging more of the lesions are incidentally discovered. Treatment of AVMs consists of neuromicrosurgery, stereotactic radiosurgery, endovascular techniques or conservative management.
Objective: To assess how to treat unruptured AVMs compared to ruptured ones.
Method: A literature search was carried out with help from supervisor. To get a synopsis of available information a search was done in "helsebiblioteket.no" using the term: AVM and treatment. An extensive search was done in PubMed using the keywords: AVM, intracranial malformations, treatment, invasive and conservative. We also hand searched following journals: Cochrane, Stroke, JAMA, NEJM and JNS. Last search was performed February 29th to ensure that the latest articles were included. Based on title and abstract relevant articles were chosen.
Results: Except for the ongoing ARUBA trial, no RCTs were found. We focused primarily on review articles published from internationally recognized databases with high impact factor. The treatment of AVM both ruptured and intact, is today based on Spetzler-Martin Grading scale and the restricted information available about the natural history.
Conclusion: The ARUBA trial will provide important information on treatment of unruptured AVMs in the future. However there is also need for a RCT that will assess interventional and conservative treatment in ruptured AVMs.