Interestingly, functional cortical reorganization has been observed in patients with AVMs: in some patients, the selleck compound primary motor cortex may undergo a certain shift towards the premotor cortex and language areas may even migrate from the dominant hemisphere to the contralateral side.17-19 Results of surgical treatment of AVMs Excellent results and high obliteration rates can be achieved after microsurgical

resection of small AVMs (less than 3 cm in diameter). According to Pikus et Inhibitors,research,lifescience,medical al,8 a 98% postoperative removal rate was achieved on postoperative angiography with less than 8.3% permanent morbidity and no mortality in 74 cases. Similar figures were obtained by Schaller and Schramm20 Inhibitors,research,lifescience,medical in 62 cases of small AVMs with 98% angiographic exclusion and only 3.2% permanent neurologic deficit. Results of stereotactic radiosurgery and AVMs Radiosurgery consists of stereotactic application of a single high-dose irradiation of the AVM nidus producing a progressive thrombosis of the lesion over a period of several months. The currently used methods include gamma knife,

linear accelerator, and heavy particles Inhibitors,research,lifescience,medical such as proton beam therapy.21-24 It is thought that ionizing radiation induces a proliferation of myofibroblasts within the connective tissue stroma of the AVM nidus as well as some endothelial proliferation.25,26 AVM obliteration has Inhibitors,research,lifescience,medical been achieved in 80% of lesions smaller than 3 cm in diameter with a hemispheric localization: using gamma knife radiosurgery in 220 patients with adequate follow-up

as defined by a postoperative angiogram 24 months after treatment, excellent results were obtained by Pollock et al22 in 73 patients with hemispheric localization and lesions smaller than 4 cm3 (diameter 2 cm or less) with low morbidity and mortality. Recently, Chang et al21 have developed a mathematical Inhibitors,research,lifescience,medical model for decision making in AVMs that takes into account several variables, such as age, size, presence of previous rupture, and life expectancy for both surgery and radiosurgery. Endovascular treatment of Isotretinoin AVMs Embolization techniques have evolved considerably during recent years in becoming both safer and more efficacious.27,28 More refined, flow-directed microcatheters can deliver polymerizing acrylic substances such as V-butyl-cyanoacrylate into even distal portions of the nidus. Using the superselectivc catheterization methods, most AVMs cannot be permanently occluded, since recanalization of the nidus occurs in the periphery of the lesions. Morbidity related to endovascular treatment consists of distal embolization and hemorrhage which remain below 8% in most series.