Brain arteriovenous malformations (AVMs) are intricate networks of blood vessels in which arteries connect directly to veins, bypassing the capillary system. This aberration can lead to serious neurological manifestations, including seizures, headaches, and hemorrhagic strokes. The embryonic development of AVMs implicates possible disruptions in arteriovenous differentiation during angiogenesis, improper regression of the primary capillary plexus, or the retention of fetal vasculature as contributing factors. Additionally, genetic mutations and environmental influences during pregnancy may facilitate AVM formation, with identified mutations in genes such as endoglin, activin receptor-like kinase 1, SMAD family member 4, and RAS p21 protein activator 1 disrupting vascular development. Such mutations are associated with conditions like hereditary hemorrhagic telangiectasia and capillary malformation-arteriovenous malformation syndrome, thus highlighting the essential role of genetic counseling in AVM management. This review underscores the importance of a deep comprehension of the embryological and genetic foundations of AVMs to refine diagnostic, therapeutic, and prognostic approaches. The paper advocates for advanced research on intervention strategies and emphasizes the significance of a genetics-focused approach in the clinical management of AVMs.

Brain arteriovenous malformations (bAVMs) are associated with a high risk of intracerebral hemorrhage, which causes severe complications in patients. Although the genetic factors leading to hereditary bAVMs have been extensively investigated, their pathogenesis are still under study. This review examines updated data on the molecular and genetic aspects of bAVMs, the architecture of microvasculature, the roles of angiogenic factors, and signaling pathways. The compiled information may help us understand the pathogenesis of both sporadic and hereditary bAVMs and develop appropriate preemptive treatment approaches.

Objective: The authors aimed for a systematic review to clarify the current role of transarterial embolization (TAE) in the management of brain arteriovenous malformations (BAVMs).

Methods: A search was conducted on PubMed, using the following terms; “brain arteriovenous malformation,” “cerebral arteriovenous malformation,” “endovascular treatment,” and “transarterial embolization.” Studies reporting the efficacy and safety of endovascular treatment for BAVMs, performed either as a standalone treatment or in conjunction with surgery or radiosurgery, were included. The final search was conducted in December 2023. Only articles written in English were reviewed. The references of publications of interest were also screened. Studies on transvenous embolization were excluded. More than 100 articles on the treatment of BAVMs were reviewed.

Results: Advances in endovascular techniques and devices have enabled TAE as a treatment modality for BAVMs, to achieve higher embolization rates. Thus, curative TAE for some BAVMs with suitable angioarchitecture has become possible. The efficacy of presurgical TAE in the treatment of low Spetzler-Martin grade BAVMs is limited; however, TAE is effective for intermediate grade BAVMs. Several reports using propensity-matched analyses reevaluated the therapeutic efficacy of pre-/post-radiosurgical TAE for BAVMs with radiosurgery-resistant lesions such as large nidus, fistulous components, and associated aneurysms. The complication rate of TAEs as a treatment modality for BAVMs is approximately 10%, and hemorrhagic complications occur in approximately 5% of cases. Despite recent advances, substantial improvements have not been observed in the morbidity and mortality associated with TAEs for the treatment of BAVMs.

Conclusion: TAE for the treatment of BAVMs is primarily performed in an adjuvant manner; however, recent advances have made standalone embolization possible. A multidisciplinary team should evaluate each case independently. Furthermore, as per recent studies, inclusive of meta-analyses, the efficacy and safety of TAEs for the treatment of BAVMs have not been elucidated. Thus, the manifestations and characteristics of BAVMs, in addition to the objective of performing a TAE, should be deliberated carefully before the endovascular procedure, to avoid complications.

Brain arteriovenous malformations (bAVMs) are uncommon vascular lesions found in young individuals exhibiting diverse clinical manifestations ranging from asymptomatic to spontaneous intracranial hemorrhage, seizures, or headaches. Despite improvements in endovascular tools and methods, standalone transarterial embolization seldom achieves success rates surpassing 50%, even when employing ethylene vinyl alcohol copolymers. Transvenous embolization (TVE) emerges as a promising option, especially for bAVMs situated distally or inaccessible through arterial routes. Despite the possibility of achieving high angiographic cure rates, concerns regarding hemorrhagic complications persist, limiting its adoption. This review article outlines the indications and methodology of TVE, discusses complications, and highlights the essential expertise needed for the safe execution of TVE along with strategies to mitigate associated risks. Clinical results reveal promising outcomes in terms of obliteration rates and favorable neurological results, although challenges persist, particularly regarding device accessibility and risk management. Despite these challenges, TVE remains a valuable alternative for managing bAVMs, particularly for cases resistant to surgical intervention, emphasizing the significance of careful patient selection and procedural expertise.