Although there is conflictive data, smaller AVMs have a higher tendency to present with hemorrhage. Neurological disability is more common in ruptured AVMs compared to aneurysm rupture due to higher likelihood of a lobar hematoma. Annual mortality rate is approximately 1.5% and 10–30% of survivors have long-term disability. In patients presenting with hemorrhage, rebleeding risk in the first year is approximately 32% that decrease to 11% in subsequent years. When there are three factors, risk may increase up to 34%. Risk factors increasing the odds of bleeding include prior history of intracranial bleeding due to AVM, deep location, exclusive deep venous drainage and single draining vein, intranidal aneurysm, and high intranidal pressure. Annual risk of bleeding of due to brain AVMs is approximately 2–4%. Symptomatic brain AVMs may present with intracranial hemorrhage (50%), seizure (33%), headache (16%), or focal neurologic deficit (6%). New endovascular techniques include balloon-assisted embolization, transvenous embolization, and double microcatheter techniques like pressure cooker technique. Mortality associated with endovascular treatment is less than 2% and permanent neurological deficit can be seen up to 2–8.9% of cases. Complications of the endovascular treatment include hemorrhage related to vessel perforation or normal pressure breakthrough phenomenon, ischemia, microcatheter retention, and other general complications associated with angiographic procedures. Targeted embolization can address intranidal or flow-related aneurysms and high flow arteriovenous shunts. Endovascular treatment can be performed for size and grade reduction, presurgical devascularization, size reduction before radiosurgery, targeted embolization, and as stand-alone treatment for cure. Depending on the grade and angioarchitectural characteristics, a combination of these modalities can be used. Treatment options for cerebral AVMs include open surgery, embolization, and radiosurgery. Annual mortality rate associated with hemorrhage is 1–5%, and 10–30% of survivors will have disability. Clinical symptoms include intracranial hemorrhage, seizure, headache, and focal neurological deficit. Cerebral arteriovenous malformations have an incidence of 0.8–1.3 per 100.000 person years. Arteriovenous malformations (AVM) are vascular malformations composed of a network of abnormal vessels connecting directly between the artery and vein without an intervening capillary bed.
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