ABSTRACT
As the knowledge of the natural history of intracranial arteriovenous malformations (AVMs) has evolved, it has become clear that these lesions, no matter their presentation, pose a significant risk to the health and welfare of those individuals harboring them. The morbidity and mortality risks associated with AVMs have been discussed in Chapter 5. Therefore, it is sufficient to say that for most patients whose life expectancy is at least 15 years, some form of treatment should be contemplated for all but the most dangerous lesions. In our opinion, the primary form of treatment for Spetzler-Martin Grades I-III lesions remains microsurgical removal. Grade VI AVMs, in general, cannot be cured without an unacceptable rate of morbidity (up to 50%) (1,2); thus the appropriate therapeutic plan for patients with these lesions is usually observation. It is in the treatment of Grade IV and V (and some Grade III) lesions that multimodality therapy is most beneficial. We will focus on these AVMs in this chapter.
