Untangling the natural history of cerebral arteriovenous malformations

Arteriovenous malformations of the brain: naturalhistory in unoperated patients. Authors : Crawford PM, West CR, Chadwick DW, et al Year Published : 1986 Number of times cited : 848 AVMs have been recognised for millennia yet continue to fascinate and stimulate debate. AVMs consist of tangles of high-flow, abnormally dilated non-nutritive vessels (termed the nidus) connecting feeding arteries with draining veins directly without the normal intervening capillary bed. The most feared complication of AVMs is bleeding into the brain substance (intracerebral haemorrhage) or subarachnoid space, which, owing to the high blood flow, can sometimes be severe. This bleeding risk is important because AVMs account for about one-third of intracerebral haemorrhages in young adults.1 Accurate understanding of the untreated clinical course of AVMs (particularly for intracranial bleeding risk, but also for epileptic seizures, death and neurological disability) is critical to counselling patients and informing any attempt at evaluating therapy. Yet, from the very first descriptions of AVMs and the origins of neurosurgery, surgical intervention began—no doubt hastened by the development of cerebral angiography in 1927—well before information on AVM outcomes was available. AVMs were then—and indeed, are still—among neurosurgery’s greatest technical operative challenges. Moreover, the stakes are high because, balanced against the risk of AVM haemorrhage, surgical intervention also carries significant morbidity. Nevertheless, it became an article of neurosurgical …