Unruptured Arteriovenous Malformations: Natural History and Management

flow vascular abnormalities characterized by intertwined feeding arteries and draining veins with no intervening capillary network. Rudolph Virchow is credited with first describing cerebral AVMs in 1863 when he defined and differentiated several intracranial vascular pathologic entities. In 1928, Walter Dandy reported 8 cases and Harvey Cushing along with Percival Bailey described treatment of 16 AVMs with catastrophic results. At that time, Cushing was quoted as stating that surgical excision of an AVM was unthinkable because of significant risk of hemorrhage. These cerebrovascular lesions represent some of the most complex pathology within the scope of neurosurgery. Their management has significantly evolved over the past century and has garnered significant attention in the neurosurgical community. The serious consequences of an AVM-related intracerebral hemorrhage (ICH) combined with the pivotal role of the neurosurgeon in the multidisciplinary treatment of AVMs make this topic of importance to the practicing neurosurgeon. This review summarizes the epidemiology, natural history, and multimodality treatment of patients with unruptured AVMs.