How Is Arteriovenous Malformation (AVM) treated?

Arteriovenous malformation treatment options often include one of three types of AVM surgery but may start with careful monitoring. Following an AVM diagnosis, which will show a group of non-cancerous blood vessels forming incorrectly, doctors will discuss AVM treatment options. These include endovascular embolization for AVM, stereotactic radiosurgery for AVM (also known as Gamma Knife surgery for AVM) and microvascular neurosurgery.

Not every AVM diagnosis results in AVM surgery. The best AVM procedure option is determined based on the location of the AVM, patient symptoms, patient health and other risks. With any surgery near or at the brain, including brain surgery for AVM, precaution is needed, as an AVM may be in a location that increases risk of tissue damage. If an AVM is growing or shows a risk of bleeding, AVM treatment options may be needed. The goal of any AVM treatment is to either cure the AVM or reduce its impact.

Brigham and Women’s Hospital provides specialized therapeutic care for unruptured and ruptured abnormalities in the veins and arteries called Arteriovenous Malformation (AVM). Left untreated, a brain or spinal AVM can rupture, leading to serious injury or death.

Our AVM Program includes national leaders in the diagnosis and treatment of AVMs. We are skilled in treating AVMs that others have deemed difficult or inoperable. Our skillful neurosurgeons recognize the emotional challenge this condition presents for patients and families. We also have witnessed the quality-of-life improvement provided by treatment.

What are Arteriovenous Malformation (AVM) Treatment Options?

Every week our team of cerebrovascular neurosurgeons, neurologists and interventional radiology specialists meets to discuss patients with cerebrovascular diseases, including AVMs, so we can determine the best AVM treatment options. Making the decision for brain surgery for AVMs is complex. We consider the risk of leaving it untreated while balancing the risks of embolization, surgery or radiation in combination or as stand-alone treatments. The goal is to cure the brain AVM with the least overall risk and best overall outcome for each person. Above all, we value your input.

1. Serial Imaging and Observation: Some brain AVMs are best left untreated after careful expert review. These are observed by yearly imaging and clinical follow-up. We are conducting research to better predict which AVMs may go on to rupture, and closely following AVMs over time to see how they change.
2. Endovascular Embolization (see video below) is a technique performed by our endovascular neurosurgeons. The purpose of this procedure, which uses a catheter to insert a glue-like substance, is to prevent blood flow to the AVM. This AVM treatment option is used in conjunction with surgery or as a stand-alone treatment.
3. Surgical Treatment (also called Open Microvascular Neurosurgery) involves using a microscope. Specialized techniques are used to remove the AVM from the spinal cord or brain. The advantage is that the AVM is then considered cured. Surgery is the first-line treatment for SMG 1 and 2 brain AVMs and most grade 3 brain AVMs. The risks of surgery are well known and based on the grade of the AVM. Our specialists will review your AVM with you to explain the risks and benefits of an individual situation.
4. Stereotactic Radiosurgery (SRS), or Gamma Knife Treatment, uses highly focused radiation that targets and intentionally damages blood vessels of the AVM. These damaged vessels produce scar tissue, which eventually seals off the brain AVM over time. While it is called radiosurgery, no incision is made. This treatment is usually for small, deep brain AVMs.

Can an AVM be Cured?

Advanced surgical techniques for AVM repair can bring life-changing results for someone living with an AVM. Our specialists in AVM surgery, aided by cutting-edge imaging, make possible the successful repair of even the most challenging AVMs.

How to Prepare for AVM Treatment

Before your AVM treatment, the BWH neurosurgery team will detail what you can expect both before the day of treatment and following the treatment. For those undergoing AVM surgery, embolization or sclerotherapy may be done before surgery to reduce the impact or risk of surgery. For patients with multiple treatments scheduled, expect at least six weeks between procedures. Many patients will return home the day of treatment, while others will remain in the hospital, especially with more advanced surgeries.

What is AVM Surgery Like?

During AVM surgery, a patient will be under general anesthesia. The surgery may last for several hours as neurosurgeons use specialized techniques to remove the AVM from the brain or spinal cord. Patients may stay in the hospital for multiple days under the careful watch of the BWH team as they undergo short-term rehabilitation. Additional brain scans can ensure the AVM has been fully removed.

Possible AVM surgery side effects include:

• Stroke or seizure
• Numbness or slow movement
• Problems with speech or memory
• Small risk of hemorrhage

How Long Does It Take to Recover from AVM Surgery?

The recovery from AVM surgery begins immediately following the procedure. A patient may stay in the hospital for a day or more but will have restricted activity for four to six weeks and may not fully recover for two to six months. Patients will need to care for their incision and manage any possible swelling or bruising around the eyes following surgery. Your doctor will work with you on when to restart any medications and if any new medications may be needed.

Contact the Center for Cerebrovascular Diseases

The Center for Cerebrovascular Diseases is home to a team of neurosurgeons – among them world leaders in the treatment of AVMs. In addition to their exceptional technical skill, our neurosurgeons are known for their clear communication, compassion, ample time spent with patients, and personal care and attention.

We understand that confronting an AVM can be frightening for many patients and families; our guiding principle is to put the patient and family first. Your physicians are accessible to you throughout your care – before, during and after the treatment period.

Our team of neurosurgeons with deep expertise in treating AVMs includes:

• Mohammad A. Aziz-Sultan, MD
• Rose Du, MD, PhD
• Kai U. Frerichs, MD
• Nirav J. Patel, MD, MA

To schedule an appointment with a physician in the AVM Program at the Center for Cerebrovascular Diseases, please contact our Patient Coordinator at: (617) 732-6600. We see new patients with AVMs as soon as the next business day.

If you are a physician seeking to refer a patient to the Center for Cerebrovascular Diseases, please call (617) 732-6600 or you can access our physicians’ office phone numbers. To contact one of our physicians with a question, patient referral or second opinion, you may also email: BWHNeurosurgery@partners.org.