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Arteriovenous Malformations Treatments
This is an abbreviated version of the complete article.*
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| Basic Facts |
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The goal of arteriovenous malformation (AVM) treatment is to eliminate the AVM(s) to prevent bleeding and control seizures. |
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The primary treatments for AVMs are endovascular embolization and radiosurgery or microsurgery. |
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Treatment decisions for an AVM must be made carefully because of the possible complications of treatment. |
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A bleeding arteriovenous malformation (AVM) is an emergency that requires immediate hospitalization. The goal of treatment is to limit bleeding, control seizures, and eliminate the AVM(s). Treatment usually begins by trying to stop the bleeding and swelling in the brain. The most common form of treatment is endovascular embolization followed by radiosurgery or microsurgical resection.
WHEN IS IT INDICATED?
Treatment for AVMs is indicated when the risk of hemorrhage is high or the AVM has bled.
WHO IS ELIGIBLE?
There are many variables involved in treating an AVM, so doctors must assess the potential benefits and risks for patients case-by-case.
WHAT TO EXPECT
Endovascular embolization. Using televised monitoring, the surgeon threads a catheter (a thin flexible tube) as close to the AVM as possible and injects contrast material through the catheter. The surgeon then deploys an embolic material through the catheter to the AVM, which blocks the flow of blood into the AVM.
Radiosurgery. Before radiosurgery (gamma knife or cyber knife), four spots on the patient's scalp are numbed with an anesthetic. A lightweight, box-shaped frame is placed over the patient's head and attached with four screws. Next, the patient undergoes imaging to pinpoint the area in the brain that needs treatment. The surgeon then directs radiation into the patient's head to obliterate the AVM.
Microsurgical resection. During this procedure, a neurosurgeon removes a portion of the skull to gain access to the brain and the AVM. The brain is carefully retracted so the surgeon can reach the AVM. The surgeon shrinks and cuts the AVM to separate it from the vessels supplying it with blood.
POST-TREATMENT GUIDELINES AND CARE
Endovascular embolization. Patients are instructed to stay in bed after the procedure and are hospitalized for 1 to 2 days.
Radiosurgery. Initially, patients undergo clinical examination and may undergo magnetic resonance imaging (MRI) right after radiosurgery. Oral steroid medications will be prescribed if a patient develops swelling of the brain.
Microsurgical resection. After surgery, patients will be neurologically monitored in the intensive care unit (ICU) for at least 24 hours. Blood pressure and urine production will be carefully monitored.
POSSIBLE COMPLICATIONS
Endovascular embolization. Complications of embolization include stroke, decrease in brain function, and death.
Radiosurgery. Complications from radiosurgery may include seizure, accelerated narrowing of blood vessels, and death.
Microsurgical resection. The complications of open brain surgery include hemorrhage, stroke, and death.
In general, the risks of surgery depend on how big and how accessible an AVM is, as well as the age and overall health of the patient.
Medical Review Date: April 1, 2009
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