Brain Arteriovenous Malformation · Surgery/Embolization/Radiosurgery

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Ruptured? + Spetzler-Martin grade
   Ruptured hemorrhage? Spetzler-Martin grade?
   • Ruptured hemorrhage → Ruptured → active cure
   • Unruptured, SM I–II (low grade) → Unruptured SM I–II → microsurgical resection
   • Unruptured, SM III → Unruptured SM III → multimodal
   • Unruptured, SM IV–V (high grade) → Unruptured SM IV–V → mostly conservative
2. [End] Ruptured → active cure
   Ruptured hemorrhage → acutely manage the hematoma/intracranial pressure, then cure by SM grade once stable (microsurgical resection/embolization/radiosurgery or multimodal); rebleeding risk is high after rupture, favoring active intervention.
3. [End] Unruptured SM I–II → microsurgical resection
   Unruptured SM I–II → microsurgical resection has a high cure rate with low morbidity (embolization may assist); unruptured cases need weighing (ARUBA suggests medical management may suit some), individualized.
4. [End] Unruptured SM III → multimodal
   Unruptured SM III → individualized multimodal (embolization + microsurgery/radiosurgery); fully weigh hemorrhage risk against treatment risk.
5. [End] Unruptured SM IV–V → mostly conservative
   Unruptured SM IV–V → mostly conservative/observation (high surgical risk); selective partial treatment for symptomatic/high-risk features (associated aneurysm/high-risk drainage); radiosurgery for small deep lesions.

Source guidelines & references

• Brain arteriovenous malformation management (Spetzler-Martin grade; ARUBA unruptured AVM)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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