The ARUBA (A Randomised trial of Unruptured Brain Arteriovenous Malformations) trial concluded medical management alone was superior to medical management with interventional therapy for the prevention of death or stroke in patients with unruptured brain AVMs [79]. However, the trial did not establish the benefit of interventional treatment of unruptured AVMs, which remains a debated issue. The optimal methods for surveillance of untreated AVMs is not well established in the literature. However, treated lesions usually require long-term follow-up, specifically lesions treated with radiosurgery or embolization. Intracranial dural AVF (dAVF) is an abnormal shunt between a dural artery and venous sinus or cortical vein. dAVFs demonstrate similar high-flow vascular shunting but lack the central nidus associated with AVM. Signs and symptoms of dAVF depend on the location, with posterior dural venous sinus lesion frequently presenting with pulsatile tinnitus or cavernous sinus lesions presenting with pain, proptosis, chemosis, and ophthalmoplegia [80]. Complications of high-grade dAVF include hemorrhage or nonhemorrhagic neurologic defects and are associated with retrograde cortical venous drainage [80-83]. Treatment via endovascular or microsurgical approach is usually indicated in high-grade dAVF with cortical venous drainage or symptomatic lesions. Observation can be utilized in lower-grade lesions with less risk of hemorrhagic or neurologic complications [80,83]. This variant covers the surveillance of both treated and untreated high-flow vascular malformations. Arteriography Cervicocerebral Cervicocerebral angiography remains the reference standard for imaging of cerebrovascular disease, including AVM and dAVF.
Cerebrovascular Diseases Aneurysm Vascular Malformation and Subarachnoid Hemorrhage PCAs. The ARUBA (A Randomised trial of Unruptured Brain Arteriovenous Malformations) trial concluded medical management alone was superior to medical management with interventional therapy for the prevention of death or stroke in patients with unruptured brain AVMs [79]. However, the trial did not establish the benefit of interventional treatment of unruptured AVMs, which remains a debated issue. The optimal methods for surveillance of untreated AVMs is not well established in the literature. However, treated lesions usually require long-term follow-up, specifically lesions treated with radiosurgery or embolization. Intracranial dural AVF (dAVF) is an abnormal shunt between a dural artery and venous sinus or cortical vein. dAVFs demonstrate similar high-flow vascular shunting but lack the central nidus associated with AVM. Signs and symptoms of dAVF depend on the location, with posterior dural venous sinus lesion frequently presenting with pulsatile tinnitus or cavernous sinus lesions presenting with pain, proptosis, chemosis, and ophthalmoplegia [80]. Complications of high-grade dAVF include hemorrhage or nonhemorrhagic neurologic defects and are associated with retrograde cortical venous drainage [80-83]. Treatment via endovascular or microsurgical approach is usually indicated in high-grade dAVF with cortical venous drainage or symptomatic lesions. Observation can be utilized in lower-grade lesions with less risk of hemorrhagic or neurologic complications [80,83]. This variant covers the surveillance of both treated and untreated high-flow vascular malformations. Arteriography Cervicocerebral Cervicocerebral angiography remains the reference standard for imaging of cerebrovascular disease, including AVM and dAVF.