There are several potential treatment options for brain AVM, and the best treatment depends on the size and location of the abnormal blood vessels. Medications may also be used to treat related symptoms, such as headaches or seizures.
Surgical removal (resection). Surgical treatment of a small brain AVM is relatively safe and effective. A section of skull is removed temporarily to gain access to the AVM. The neurosurgeon, aided by a high-powered microscope, seals off the AVM with special clips and carefully removes it from surrounding brain tissue. The skull bone is then reattached, and the scalp is closed with stitches.
Resection is usually done when the AVM can be removed with acceptable risk to prevent hemorrhage or seizures. AVMs that are in deep brain regions carry a higher risk of complications. In these cases, other treatments may be considered.
Endovascular embolization. During this procedure, a long, thin tube called a catheter is inserted into a leg artery and threaded through the body to the brain arteries. The catheter is positioned in one of the feeding arteries to the AVM, and small particles of a glue-like substance are injected to block the vessel and reduce blood flow into the AVM.
Endovascular embolization may be done alone, before other treatments to reduce the size of the AVM, or before surgery to reduce the chance of bleeding during the operation. In some large brain AVMs, endovascular embolization may reduce stroke-like symptoms by redirecting blood back to normal brain tissue.
- Stereotactic radiosurgery. This treatment uses precisely focused radiation to destroy the AVM. The radiation causes the AVM vessels to slowly clot off in the months or years following the treatment. This treatment works best for small AVMs and for those that have not caused a life-threatening hemorrhage.
If you have few or no symptoms or your AVM is in an area of your brain that's hard to treat, your doctor may advocate a more conservative approach and monitor your condition with regular checkups.
Feb. 12, 2011
- Arteriovenous malformations and other vascular lesions of the central nervous system fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/avms/detail_avms.htm. Accessed Dec. 6, 2010.
- Singer RJ, et al. Brain arteriovenous malformations. http://www.uptodate.com/home/index.html. Accessed Dec. 6, 2010.
- What is an arteriovenous malformation (AVM)? American Heart Association. http://www.strokeassociation.com/presenter.jhtml?identifier=3067293. Accessed Dec. 7, 2010.
- Smith WS, et al. Cerebrovascular diseases. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: The McGraw-Hill Companies. http://www.accessmedicine.com/content.aspx?aID=2905728&searchStr=intracranial+arteriovenous+malformation#2905728. Accessed Dec. 6, 2010.
- Zhao J, et al. Surgical treatment of giant intracranial arteriovenous malformations. Neurosurgery. 2010;67:1359.
- Brown RD, et al. Natural history, evaluation, and management of intracranial vascular malformations. Mayo Clinic Proceedings. 2005;80:269.
- Pollock BE, et al. A proposed radiosurgery-based grading system for arteriovenous malformations. Journal of Neurosurgery. 2002;96:79.
- Lanzino G, et al. Onyx embolization of arteriovenous malformations. Journal of Neurosurgery. 2010;113:731.
- Brown RD (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 10, 2011.