Toward a molecular era in brain arteriovenous malformation management

Brain arteriovenous malformations (bAVMs) are one of the most enigmatic challenges in vascular neurology. Unlike other cerebrovascular diseases, such as aneurysms or ischemic stroke where treatment protocols have become increasingly standardized and outcomes have improved, management of bAVMs remains controversial and individualized. Particularly in unruptured cases, the decision to intervene hinges on complex risk–benefit considerations, compounded by the lack of robust predictive data and the limited curative potential of current therapies. Recent molecular advances are paving the way for a shift from angioarchitecture based bAVM treatment toward mechanism informed strategies. By uncovering somatic mutations and dysregulated signaling pathways, these findings open the door to targeted therapies and combination approaches, offering a potential paradigm shift in how AVMs are managed.