On The Horizon for Cerebral Arteriovenous Malformations in Children

  • Improving operating room design:  Surgical management of AVMs requires integration of many different technologies – frameless stereotactic guidance, surgical microscopy, and real-time imaging, including ultrasonography and catheter-based angiography.  Even high-volume institutions commonly employ an ad hoc approach to operating room design, limited by space, funding, and technology.  However, there is an increasing appreciation of the benefits of using integrated systems within a single theater to provide safer procedures with shorter operative times.  In addition, the ability to overlap function (as is seen with frameless stereotaxy and microscopy for neurosurgeons and with angiography for cardiology and vascular surgery) has opened the possibility of shared resources (54).
  • New embolization agents and techniques:  Successful embolization of AVMs can improve surgical outcomes.  The continued development of increasingly safe and accurate methods to deliver embolic agents, such as smaller and steerable microcatheters, will continue to expand the spectrum of treatable lesions.
  • Earlier detection: One of the major concerns with AVMs is the morbidity that accompanies hemorrhage.  Early detection of these lesions prior to hemorrhage, along with identification of those lesions most prone to bleeding and thus the best candidates for treatment, could potentially improve the outcomes of children affected with AVM.  While still at the very early stages, the study of biochemical and radiographic biomarkers capable of detecting AVMs and identifying those at greatest risk of bleeding is ongoing.