A cerebral arteriovenous malformation (AVM) is an irregular connection of arteries and veins within the brain that has no definite cause; many do not experience symptoms (Mayo Clinic Staff, 2011). However, some patients experience headaches and seizures (Starke et al., 2009). The main risk of an AVM is hemorrhage, and patients with AVMs will always have some risk of hemorrhage (Ogilvy et al., 2001); According to Ogilvy et al (2001), more than 50% of AVMs lead to cerebral hemorrhage. The severity of the AVM will determine whether the condition should be treated and how it should be treated. Although treatment of AVMs in the brain attempts to maximize quality of life as well as eliminate cerebral hemorrhage risk, pre-treatment consideration of benefits and risks is essential.
The four major treatments of AVMs in the brain include resection, endovascular embolization, stereotactic radiosurgery, and multimodality (Ogilvy et al., 2001). Resection of the AVM is simply surgical removal of the lesion with the goal of total obliteration. Endovascular embolization utilizes a catheter to inject a glue-like substance to block the AVM (Mayo Clinic Staff, 2011). According to Ogilvy et al. (2001), stereotactic radiosurgery is a type of focused radiation that destroys the AVM. Multi-modal treatment is a combination of two or more treatments, and the most common form of multi-treatment is embolization paired with either resection or radiosurgery (Ogilvy et al., 2001). Endovascular embolization can be used to reduce the size of the AVM and therefore make either resection or radiosurgery more effective in reducing hemorrhage risk (Mayo Clinic Staff, 2011). The Spetzler-Martin scale is often used to determine relative risk analysis deciding the safest form of treatment for a specific AVM (Ogilvy et al., 2001). This scale is a five point grading scale which involves size, location, parts of the brain that control motor functions, language, and senses (eloquence), and venous drainage to determine how to manage an AVM (Ogilvy et al. 2001; Kim et al., 2012).
Statement of the Problem
The most common treatments for AVMs are resection, endovascular embolization, stereotactic radiosurgery, as well as a combination of treatments (Mayo Clinic Staff, 2011). According to Ogilvy et al. (2001), the overall risk of hemorrhage without treatment of an AVM increases ≈2% to 3% every year. Researchers have shown that risk for recurrent hemorrhage increases after the first hemorrhage (Ogilvy et al., 2001). Therefore, the focus of this study will pertain to treatment of AVMs to reduce the risk of hemorrhage as much as possible. Although treatments are typically successful, one must monitor the risk of hemorrhage if the AVM was not completely obliterated. Prior to finalizing treatment plans, risks of the treatment are measured. To decide which treatment will be most successful for a patient, the Spetzler-Martin scale is typically used (Kim et al., 2012)....