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