Arteriovenous Malformation

Treatment

Mayo Clinic doctors who have training in brain conditions (neurologists), brain surgeons (neurosurgeons), brain imaging specialists (neuroradiologists) and other specialists with experience in treating arteriovenous malformations (AVM) work with you to provide the most appropriate care. Generally, a neurologist or neurosurgeon with expertise in blood vessel (vascular) conditions will help lead the care team, coordinating your care and serving as your main contact.

Doctors will discuss with you all your treatment options and develop an individualized treatment plan based on your risk of complications, the location and size of the AVM and your overall health.

Treatment may include:

• Surgical removal (resection). In this procedure, your neurosurgeon removes a section of your skull temporarily to view your AVM through a high-powered microscope. Your surgeon seals off the AVM using special clips or a laser and uses small cautery tools to carefully remove the AVM from surrounding brain tissue. Your surgeon then reattaches the skull bone and closes the incision in your scalp.

  Sometimes your surgeon may perform this procedure while you are awake (awake brain surgery). Your responses to questions during the procedure help your surgeon avoid injuring areas of your brain that control speech or movement.

  Usually, while you're under general anesthesia, your doctor will order an angiogram to ensure the AVM is completely gone. If any of the AVM remains, you may immediately return to the operating room for further surgery.

• Stereotactic radiosurgery. Stereotactic radiosurgery uses precisely focused radiation to destroy your AVM. In this procedure, the radiation causes the AVM blood vessels to slowly close in one to three years after treatment. You won't need general anesthesia or an incision. Stereotactic radiosurgery may be an option if you have a small arteriovenous malformation that hasn't caused a life-threatening hemorrhage.

• Endovascular embolization. In this procedure, a doctor inserts a long thin tube (catheter) into an artery in your leg and threads it through blood vessels to your brain using X-ray imaging. Your surgeon places the catheter in one of the arteries that feeds your AVM and injects small particles or a gluelike substance to block the artery and reduce blood flow into the AVM.

  Often, surgeons perform embolization before surgery to reduce the chance of bleeding during the operation, or to reduce the size of the AVM so stereotactic radiosurgery or conventional surgery can be more effective. If you have a large AVM that appears inoperable, embolization may reduce your symptoms by redirecting blood back to the normal brain tissue.