Intracranial Arteriovenous Malformations PDF

Preface

During the past twenty years, great strides have been made in the management of intracranial arteriovenous malformations. This success has resulted not so much fromgreater understanding of the pathophysiology or anatomy of the lesions as it has from new technologies applied in their management. The greatest advances have been multifactorial. Endovascular therapy, which improves our ability to resect complex lesions, is probably the most important cause for the reduction in the incidence of postoperative hemorrhage. Intraoperative angiography, which allows confirmation of complete resection, again reduces the incidence of postoperative hemorrhage. Improvements in surgical instrumentation, such as microscopes and the bipolar cautery, have made microsurgery more effective. Improved surgical approaches have allowed the successful resection of more complex lesions. Surgical planning has been facilitated by more sophisticated preoperative imaging, including angiography, magnetic resonance imaging, magnetic resonance angiography, computed tomography angiography, and functionalmagnetic resonance imaging. Stereotactic radiosurgery has provided an avenue for the treatment of deep, small arteriovenous malformations. The perioperative care of our patients has been enhanced with advances in anesthesia and the creation of neurointensive care units. Each of these parameters is thoroughly reviewed in this volume, and, more importantly, all are coordinated into a cohesive management scheme.

In this text we seek to document current understanding of the management of intracranial arteriovenous malformations and to define advances in the field. We begin with a review of the anatomy, classification, and pathophysiology of arteriovenous malformations. We then progress to detailed discussion of diagnosis and management. Preoperative evaluation with diagnostic and functional imaging as well as surgical planning is reviewed in detail. We conclude with consideration of future directions for treatment. A review of these chapters will enable the reader to provide the patient with better preoperative risk analyses, a thorough review of the treatment options and their risks, and a general outline of a specific treatment regimen. Selecting patients for therapy or not, and then selecting the appropriate therapy are the greatest challenges presented to the treating physician. Once treatment is recommended, integration of the complex modalities is essential. The authors of these chapters provide the reader with such insight.

Each arteriovenous malformation presents clinical challenges on the basis of its size and location. These issues, which play a large part in our success in treating these lesions, are dealt with in individual chapters. The authors thoroughly discuss the surgical nuances of arteriovenous malformations in specific locations. The application of endovascular therapy as curative or, more commonly, as an adjuvant therapy is reviewed. Current understanding of the limits and complications of stereotactic radiosurgery, as well as the promise of future applications, is presented. Risks and benefits for each form of therapy are fully detailed. Finally, the application of each treatment modality is integrated into treatment algorithms based on history, location, size, and risk benefit analysis. It is the intent of the editors and authors to provide the reader with a framework for understanding and treating these complex lesions.

This volume is designed for all individuals involved in the management of intracranial arteriovenous malformations. It is the only text that comprehensively reviews the subject. The authors have provided an extensive and thorough discussion of the scientific data from the literature in a prose that is easily readable and understandable for clinical application. The reader is offered an integrated system, including medical management, anesthesia, radiation therapy, neuroradiology, endovascular therapy, and microsurgery, for the management of one of the most challenging lesions presented to physicians involved in the care of patients with neurologic disease.

We are indebted to the members of our families for the time they gave up with us so that this volume could be created. We thank Mr. Robert Gallavan and Ms. Jessica Kazmier at our institutions for their dedicated assistance. We are grateful for the skillful editorial guidance of Ms. Arlene Stolper Simon, who spent countless hours editing chapters and working with the authors. Finally, we acknowledge the support and direction provided by our Informa Healthcare USA team, Ms. Vanessa Sanchez and Mr. Alan Kaplan.