How is Arteriovenous Malformation (AVM) treated? 

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 the Arteriovenous Malformation (AVM) treatment options at Brigham and Women’s Hospital?

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 treatment options. The decision making for brain 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 carefully observed by yearly imaging and clinical follow up. We are conducting research to better predict which AVMs may go on to rupture, and carefully 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 is to prevent blood flow to the AVM, which 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 the AVM is then considered cured. Surgery is the first line treatment for SMG 1 and 2 brain AVMs, as well as most grade 3 brain AVMs. The risk for 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.

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.

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 additional 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.