Contemporary management of large-volume arteriovenous malformations: a clinician’s review

Abstract

Arteriovenous malformations (AVMs) represent a heterogeneous group of lesions, and as such, there exist several treatment options and approaches depending on size, location, grading, and symptoms. Large-volume AVMs represent a particularly challenging subset of AVMs with controversy over the very classification with definitions based on size, volume, and Spetzler-Martin grade. With regards to treatment paradigms, the natural history of these lesions is an important foundation upon which management principles have been built. At this time, management options range from observation with medical management to interventions including radiosurgery, microsurgery, embolization, or a combination of these approaches. In light of the challenges facing clinicians, we performed a literature review of AVMs with a specific focus on the management of large-volume AVMs with respect to outcomes, toxicity, and future treatment options. Based on the review, we have proposed a comprehensive risk-based treatment algorithm for the management of large-volume AVMs.

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