Advanced brain arteriovenous malformation embolization techniques

Brain arteriovenous malformations (bAVM) have a low incidence, but a 2-4% overall annual hemorrhage rate with significant morbi- mortality risk when ruptured. Treatment options include micro- surgical resection, stereotactic radiosurgery, and embolization, which may be performed alone or in variable combinations. Heterogeneous with the individualized risks in every case, there is no consensus on the treatment indications and the method to approach the cases, particularly those that are unruptured. Endovascular treatment of bAVMs has been controversial in terms of safety and efficiency, especially after the ARUBA results emerged, despite being highly criticized. Since then, there have been many advancements in endovascular bAVM treatment, not only in devices and materials, but also in techniques such as the refinement of transvenous embolization and, most recently, the introduction of the curative multiplug flow control technique. This review describes and discusses advanced embolization techniques.