Transvenous Approach to Intracranial Arteriovenous Malformations: Challenging the Axioms of Arteriovenous Malformation Therapy?

Neurosurgery. 2015 Oct;77(4):644-51; discussion 652. doi: 10.1227/NEU.0000000000000869.


: A compartmental conceptualization of intracranial arteriovenous malformations (AVMs) allows recognition of feeding arteries, an intervening plexiform nidus, and draining veins. AVM therapy involves eliminating the nidus, which is the source of hemorrhage, without compromising normal arterial and venous drainage of the brain. Traditional methods of AVM therapy through microsurgery and endovascular embolization involve arterial devascularization, with preservation of AVM venous drainage, until the nidus is excluded. The transvenous approach in treating vascular malformations was popularized by successful treatment models for dural arteriovenous fistulas. More recently, high-flow intracranial AVMs are being managed with transvenous endovascular approaches, although this novel technique has its challenges and perils. We review the current literature on transvenous AVM therapy and highlight its role for AVM therapy in the present day.

Publication types

  • Review

MeSH terms

  • Animals
  • Brain / diagnostic imaging
  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Central Nervous System Vascular Malformations / therapy
  • Cerebral Veins / diagnostic imaging*
  • Cyanoacrylates / administration & dosage
  • Embolization, Therapeutic / methods*
  • Humans
  • Intracranial Arteriovenous Malformations / diagnostic imaging*
  • Intracranial Arteriovenous Malformations / therapy*
  • Radiography
  • Sclerotherapy / methods


  • Cyanoacrylates
  • MK 6 cyanoacrylate