Arteriovenous Malformation (AVM)

Arteriovenous malformations treatment

Can AVM be cured?

How long does an AVM surgery take?

How long does it take to recover from AVM surgery?

Can AVM cause personality changes?

What is the survival rate of an AVM?

How serious is a brain AVM?

 

 

Can AVM be cured?

Gamma Knife Radiosurgery is a one-day outpatient procedure in which beams of radiation are precisely focused on the AVM, causing it to shrink over time. In most patients, the AVM will be cured in 1-3 years after treatment. Such radiosurgery is most useful for smaller AVMs, but can be used selectively for the treatment of larger AVMs.

A small catheter (tube) is used in Endovascular Embolization inpatient procedure. The catheter is passed from a blood vessel in the groin (or arm) up into the AVM, where glue or other material is injected. Endovascular embolization is primarily used in preparation for surgery or radiosurgery to make the treatments safer and more effective. In some cases, the treatment can cure the AVM, making surgery or radiosurgery unnecessary.

 

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Treatment

Treatment for AVM depends on where the abnormality is found, the symptoms that you have and your overall health. Sometimes, an AVM may be monitored with regular imaging tests to watch for changes or problems. Other AVMs require treatment. Determining whether or not an AVM needs treatment involves factors such as:

  • If the AVM has bled
  • If the AVM is small enough to treat
  • If the location of the AVM is in a part of the brain that can be reached

Medications

Medications can help manage symptoms such as seizures, headaches and back pain.

Surgery

The main treatment for AVM is surgery. Surgery may be recommended if you're at a high risk of bleeding. The surgery may completely remove the AVM. This treatment is usually used when the AVM is small and located in an area where surgeons can remove the AVM with little risk of causing significant damage to the brain tissues.

Endovascular embolization is a type of surgery in which the surgeon threads a catheter through the arteries to the AVM. Then a substance is injected to create an artificial blood clot in the middle of the AVM to temporarily reduce the blood flow. This may also be done before another type of surgery to help reduce the risk of complications.

Sometimes stereotactic radiosurgery is used. This procedure is usually performed on small AVMs that have not ruptured. This uses intense, highly focused beams of radiation to damage the blood vessels and stop the blood supply to the AVM.

Deciding whether or not to treat an AVM is a decision that you and your doctor will discuss carefully together, weighing the possible benefits against the risks.

 

 

 

 

 

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Surgery is the most common treatment for brain AVMs. There are three different surgical options for treating AVMs:

  • Surgical removal (resection).

If the brain AVM has bled or is in an area that can easily be reached, surgical removal of the AVM via conventional brain surgery may be recommended. In this procedure, your neurosurgeon removes part of your skull temporarily to gain access to the AVM.

With the help of a high-powered microscope, the surgeon seals off the AVM with special clips and carefully removes it from surrounding brain tissue. The surgeon then reattaches the skull bone and closes the incision in your scalp.

Resection is usually done when the AVM can be removed with little risk of hemorrhage or seizures. AVMs that are in deep brain regions carry a higher risk of complications. In these cases, your doctor may recommend other treatments.

  • Endovascular embolization.

In this procedure, your doctor inserts a long, thin tube (catheter) into a leg artery and threads it through blood vessels to your brain using X-ray imaging.

The catheter is positioned in one of the feeding arteries to the AVM, and injects an embolizing agent, such as small particles, a glue-like substance, microcoils or other materials, to block the artery and reduce blood flow into the AVM.

Endovascular embolization is less invasive than traditional surgery. It may be performed alone, but is frequently used prior to other surgical treatments to make the procedure safer by reducing the size of the AVM or the likelihood of bleeding.

In some large brain AVMs, endovascular embolization may be used to reduce stroke-like symptoms by redirecting blood back to normal brain tissue.

  • Stereotactic radiosurgery (SRS).

This treatment uses precisely focused radiation to destroy the AVM. It is not surgery in the literal sense because there is no incision.

Instead, SRS directs many highly targeted radiation beams at the AVM to damage the blood vessels and cause scarring. The scarred AVM blood vessels then slowly clot off in one to three years following treatment.

This treatment is most appropriate for small AVMs that are difficult to remove with conventional surgery and for those that haven't caused a life-threatening hemorrhage.

 

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How long does an AVM surgery take?

The surgery may take several hours. How long depends on the difficulty encountered by the surgeons. At the end of the surgery, a head dressing will be applied to your head and you will be taken to the Neurosurgical Intensive Care Unit where you will be observed closely. You will be moved back to your room in 1-2 days.

 

Follow-up

After treatment for an AVM, you may need regular follow-ups with your doctor. You may need more imaging tests to make sure that the AVM is completely resolved and that the malformation has not recurred. You may also need regular imaging tests and follow-up visits with your doctor if your AVM is being monitored.

 

How long does it take to recover from AVM surgery?

You may feel more tired than usual for several weeks. You may be able to do many of your usual activities after 4 to 6 weeks. But you will probably need 2 to 6 months to fully recover. This care sheet gives you a general idea about how long it will take for you to recover.

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Can AVM cause personality changes?

AVMs can cause all kinds of trouble in the brain. If the frontal lobe is involved, such as an AVM in the parietal lobe, it can 'steal' blood from other parts of the brain that could result in a change in personality.

 

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What is the survival rate of an AVM?

The prognosis of an AVM depends on several factors, beginning with whether the AVM is discovered before or after bleeding. More than 90% of those who bleed survive the event. The biggest concern related to AVMs is that they will cause uncontrolled bleeding, or hemorrhage. Fewer than 4 percent of AVMs hemorrhage, but those that do can have severe, even fatal, effects. Death as a direct result of an AVM happens in about 1 percent of people with AVMs.

 

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How serious is a brain AVM?

There are risks involved in any brain surgery, including infection and neurological impairment, but a successful surgical resection that completely removes an AVM virtually eliminates the risk of a future rupture.

 

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10 common questions about Arteriovenous malformations treatment

1Can an AVM be cured?
In most patients, the AVM will be cured in 1-3 years after treatment. Such radiosurgery is most useful for smaller AVMs, but can be used selectively for the treatment of larger AVMs. Endovascular Embolization: A small catheter (tube) is used in this inpatient procedure.
2What causes arteriovenous malformations?
The cause of cerebral AVM is unknown. An AVM occurs when arteries in the brain connect directly to nearby veins without having the normal small vessels (capillaries) between them. AVMs vary in size and location in the brain. An AVM rupture occurs because of pressure and damage to the blood vessel.
3What is the survival rate of an AVM?
Overall mortality rates in AVM patients range from 0.7%–2.9% per year [9].
4Is arteriovenous malformation life threatening?
Bleeding in the brain (hemorrhage). An AVM puts extreme pressure on the walls of the affected arteries and veins, causing them to become thin or weak. ... Some hemorrhages associated with AVMs go undetected because they cause no major brain damage or symptoms, but potentially life-threatening bleeding episodes may occur
5Can AVM grow back?
Since AVMs do not grow back, the cure is immediate and permanent if the AVM is removed completely. The risks of surgery are considered to be high for AVMs that are located in deep parts of the brain with very important functions
6Are venous malformations dangerous?
Venous malformations can occur near the surface of the skin or deep inside the body. ... If the skin that covers the malformation is very thin and becomes stretched as it grows, it can bleed. Blood can pool in the dilated veins, resulting in painful, but not dangerous, blood clots, known as thrombophlebitis
7What is the recovery time after AVM surgery?
You may feel more tired than usual for several weeks. You may be able to do many of your usual activities after 4 to 6 weeks. But you will probably need 2 to 6 months to fully recover. This care sheet gives you a general idea about how long it will take for you to recover.
8Is arteriovenous malformation genetic?
No environmental risk factors have been identified for neurological AVM. AVM does not usually run in families, but somewhere on the order of 5% of AVMs may be due to autosomal dominant inheritance of a genetic mutation, most commonly hereditary hemorrhagic telangiectasia or the capillary malformation-AVM syndrome
9Is AVM surgery dangerous?
Resection is usually done when the AVM can be removed with little risk of hemorrhage or seizures. AVMs that are in deep brain regions carry a higher risk of complications
10Can AVM cause personality changes?
Do you believe AVMs cause personality changes even before they bleed? ... If the frontal lobe is involved, such as an AVM in the parietal lobe, it can 'steal' blood from other parts of the brain that could result in a change in personality. An MRI may be able to help sort that out

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