This protocol addresses the management of a diagnosed but unruptured brain arteriovenous malformation (bAVM). The optimal treatment approach for unruptured bAVMs remains a subject of active clinical debate, reflecting limited high-quality evidence on long-term haemorrhage risk and treatment complications.
The patient presents with an unruptured brain arteriovenous malformation. Management decisions must weigh the lifetime risk of intracranial haemorrhage against the procedural risks associated with intervention. Evidence from randomised controlled trials in this specific population is limited — only one such trial (ARUBA) has been conducted to inform this decision.
When intervention is indicated, the goal is complete obliteration of the nidus and arteriovenous shunt. Available interventional strategies include targeted surgical and/or radiosurgical techniques, with selection guided by the specific anatomical characteristics and grade of the malformation.
The primary endpoint is complete elimination of the bAVM nidus and arteriovenous shunt. Depending on the modality selected, obliteration may be confirmed immediately or may be assessed over a follow-up period of years.