Abstract
Arteriovenous malformations (AVMs) show incredible diversity. In Japan, multimodal treatment involving craniotomy, endovascular treatment, and radiotherapy is widely used to leverage the strengths and minimize the weaknesses of each individual treatment method. With the approval of Onyx, a non-adhesive liquid embolic agent, endovascular embolization has come to play an exceedingly important part in AVM treatment. While the curative capacity of embolization alone has markedly increased, embolization is of particular use in an adjuvant role for facilitating bleeding control during craniotomy for resection. N-butyl-cyanoacrylate (NBCA) has the major advantage that its concentration can be freely adjusted, leading to a central role in the embolization of high-flow feeders and targeted embolization for which Onyx is less effective. Moreover, the superior curative capacity of craniotomy for resection and the low-invasiveness of stereotactic radiosurgery also play an important part in multimodal therapy. In the present paper, we compare the current state of AVM treatments and ARUBA study findings and discuss the future of AVM treatment.
