How Can a Brain AVM be Treated?

• Risk Factor Reduction and Close Monitoring with Imaging
  • Depending on your Age, Risk Factors,  Location, and Size of the AVM, many people may be at Lower Risk for Developing Symptoms or having their AVM Rupture.  We may advise that risk factors such as Blood Pressure and Smoking Cessation be managed with Serial Imaging be performed to monitor your Brain AVM.  If the AVM shows signs of Growth or has a change in it’s Morphology (shape changes or an irregularity develops) or Bleeds (Hemorrhages), further Treatment options may be considered.  Many Brain AVMs that have NOT Bled into the Brain or cause minimal symptoms may be cautiously observed and treated with medications for the symptoms and monitored closely for signs of worsening.
• Neurointerventional or Neuroendovascular Therapy
  • If a Person is Young, or has certain Risk Factors such as Congenital Medical Condition (Heriditary Hemorrhagic Telangiectasia -HHT), or Known Bleeding Event, Minimally Invasive Treatment of their AVM may be considered.
  • Neurointerventional Therapy is performed by accessing the Blood Vessels through a small incision in the Leg (Femoral Artery) or Arm (Radial or Axillary Artery) and Navigating small “Tubes” or Catheters into the Brain.  Several Different Treatment Strategies may be employed to treat a Brain AVMs including Embolization or “Blocking” of their Abnormal Blood Vessels or “Shunts” using Blocking Agents such as “Glue” or NBCA, or Onyx.  Sometimes, special adjunctive devices such as a Balloon may also be utilized to effect a more durable result and lower the risks. The Recovery Period for these Techniques is usually very short, as little as 1-2 days in the Hospital.  Embolization Therapy may be performed as the Definitive Procedure to Cure some AVM’s or as an Adjunctive Pre-Operative Procedure to make Surgical Excision Safer or Radiosurgery more effective.
• Microsurgical Therapy
  • In some Patients, the AVM may not be “Cured” with Embolization Alone and Open-Brain Surgical Therapy or a Craniotomy is performed to Surgically Excise or Remove the AVM.  
• Radiosurgery
  • In some Patients, especially those presenting with Unruptured AVM’s (those that have NOT Hemorrhaged), and the AVM is Small or greatly reduced in size with Embolization, Doses of Radiation can be Targeted to the Abnormal Blood Vessels to “Scar” them and allow them to Heal.  The effects of Radiosurgery, however, are not immediate and may take 3-5 years to ultimately maximize their therapeutic effects.
• Risks of Treatment
  • Monitoring
    • There is the possibility that an AVM may Rupture or Grow during a surveillance period before there is an opportunity to treat with Neurointerventional or Surgical techniques.  This may result in severe Brain Injury or Death associated with the Brain Hemorrhage as described above.
  • Neurointerventional Therapy
    • When a Person undergoes treatment of their AVM, there are risks that the AVM may rupture or that an important blood vessel may become blocked during the Operation.  This could result in Severe Permanent Brain Injury or Stroke, Long-Term Permanent Disability, or even Death.  These risks may vary based on the complexity of the Brain AVM.
  • Microsurgical or Open Brain Surgery Treatment
    • As with Neurointerventional Therapy, the AVM may rupture or an important blood vessel may be occluded during the Operation which can result in Permanent Disability or Death.  Open Brain Surgery also carries the additional risks of direct manipulation of the Brain and associated Brain Injury and is generally associated with longer recovery times and side-effects, including a risk of developing seizures.
  • Radiosurgery
    • Delivering High Doses of Radiation targeted to the AVM may have secondary damage to nearby normal brain tissue resulting in long-term injury or symptoms of “Stroke”.  In addition, the delayed Therapeutic Effects of 3-5 years still carries the Risks of the AVM Bleeding during the Healing period.