Current treatment strategies and neurosurgical practice for cerebral AVMs

Management strategies for cerebral arteriovenous malformations(AVM)have undergone considerable evolution with the advent of advance in surgical, endovascular, and radiosurgical technologies. However, controversy still remains regarding the indications for invasive treatment, especially for unruptured lesions as demonstrated by the results of a randomized trial of unruptured brain arteriovenous malformation (ARUBA)study. Similarly, the role of acute craniotomy remains to be elucidated. This article describes our current strategy for those complex lesions and illustrates recent futuristic technologies and techniques aiming to improve outcomes in AVM surgeries. Particularly, the significance of patient selection, and the choice of preoperative and intraoperative endovascular treatment(hybrid surgery)are discussed.