To make an appointment, please call our program coordinator at 617-525-8128 or submit a request through our secure online form.
A brain arteriovenous malformation (AVM) is a tangle of abnormal blood vessels connecting arteries and veins. It’s essentially, a miswiring of the brain’s blood vessels. You can think of it as a plumbing mistake that happens during brain development before birth.
Normally, arteries bring oxygen-rich blood from the heart to tissues, and veins carry oxygen-depleted blood back to the heart. The blood passes through small vessels called capillaries in between. Capillaries slow the blood down so that organs like the brain can absorb oxygen and nutrients.
In an AVM, high-pressure blood from arteries flows directly into veins, skipping the step of going through the capillaries. Over time, this can cause the vessels to stretch, weaken, and rupture. This kind of connection is generally occurring during embryogenesis in utero.
Most AVMs are congenital, meaning they form in the womb. They are not typically inherited or caused by anything someone did or didn’t do.
A previously unruptured brain AVM carries an average annual bleeding risk of 2.2%. That risk increases after a first bleed, which is why timely and personalized care is so important.
Many people with AVM live their whole lives not knowing about it because they have no symptoms. However, when an arteriovenous malformation causes symptoms, they can be life-threatening. People with AVM are at a higher risk of bleeding in the brain.
At Brigham and Women’s Hospital, we provide compassionate, patient-centered diagnosis and comprehensive treatment for brain and spinal AVMs. Our goal is to guide each patient through their journey without losing function, independence, or life satisfaction. We take time to understand your priorities, answer your questions, and develop a treatment or monitoring plan that makes sense for your unique situation.
Our care team includes experienced cerebrovascular neurosurgeons, neuro-interventional radiologists, vascular neurologists, and radiation oncologists who collaborate through an interdisciplinary approach to provide the most effective treatment options available, including minimally invasive AVM surgery and stereotactic radiosurgery.
Our clinicians regularly participate in cerebrovascular research and clinical trials, so we are able to bring the most recent and advanced treatments to our patients.
An AVM can form anywhere in the body, but the most common places are in the brain or spinal cord. These places also carry the greatest risk of complications. AVMs in the brain can rupture, causing a hemorrhagic stroke. Even if a brain AVM doesn’t bleed, it can still cause serious symptoms.
Many people with an arteriovenous malformation never show signs of AVM. When arteriovenous malformation symptoms appear, they can affect many body systems, depending on where in the brain they form. Possible symptoms of AVM include:
If an AVM bleeds into the brain, it can rupture and cause a hemorrhagic stroke. Symptoms of a rupture may come on suddenly, including nausea and vomiting, severe headache, and loss of consciousness. A ruptured AVM is a life-threatening emergency. If you or someone you know experiences these symptoms, seek immediate medical attention.
An AVM usually forms during a baby's development in the womb or shortly after birth. It's possible, but rare, for an arteriovenous malformation to develop in an adult.
Experts don't know what causes an arteriovenous malformation. In rare cases, there may be a genetic component, but most AVMs don't appear to be hereditary.
Rupture is the most dangerous outcome of an arteriovenous malformation. High or increased blood pressure is a common risk factor. The high blood flow through the AVM can weaken the walls of the blood vessels over time. As the walls get weaker, increased pressure is more likely to cause AVM rupture.
AVMs can affect anyone. It's most common for symptoms to appear between the ages of While arteriovenous malformations are about equally common in men and women, evidence suggests they’re more likely to be deadly in biological males.
Brain arteriovenous malformations are often found by chance, for example, during imaging after a head injury, car accident, or evaluation for chronic headaches. They can also be discovered if they cause symptoms, such as a seizure, a bad headache, or bleeding in the brain. Bleeding from a brain AVM is the leading cause of hemorrhagic stroke in young adults.
If your doctor suspects an AVM, they will use imaging to examine the blood vessels and confirm a diagnosis. Possible imaging tests include:
Following an AVM diagnosis, doctors will discuss AVM treatment options.
There are currently no drugs proven to treat arteriovenous malformation, but there are several effective arteriovenous malformation treatment options, including:
Despite the variety of treatment techniques, not every AVM diagnosis leads to surgery. Depending on the location of the malformation, your health, and the severity of symptoms, you and your care team may decide to wait and monitor the AVM instead of operating.
For those undergoing AVM surgery, embolization or sclerotherapy may be performed first to reduce the impact or risk of surgery.
Choosing how, and whether, to treat a brain AVM is a deeply personal decision. Each case is unique, and different medical centers may recommend different approaches based on their expertise and what’s most important to the patient. We believe that getting multiple opinions is helpful for making a decision, and we’re here to help you understand your choices and make a decision that fits your life, values, and goals.
The goal of AVM treatment is to cure the condition with the least possible risk. A cure means the AVM is completely removed or sealed off, so it can no longer bleed.
AVMs can't go away on their own. However, there are surgical techniques that can treat or cure AVM.
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 completely removed.
Like any surgery, AVM resection carries some risks. Some patients may experience temporary changes that improve with time, while others may have permanent changes. That’s why every decision is made with great care. Your care team will talk with you about the potential risks and benefits, and work with you to create a treatment plan that supports both your health and quality of life.
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 help determine when to restart any medications and if any new medications may be needed.
Yes, many people with an AVM can live a normal, active life, especially if the AVM is small, unruptured, and not causing symptoms. Only about 12% of people with an arteriovenous malformation will experience any symptoms. Many people with AVMs may not even realize they have one.
However, when an AVM causes symptoms or ruptures, the consequences can be life-threatening. If you have symptoms of AVM or if you've been diagnosed with an AVM, it's important to work closely with your care team to understand your specific risks and options.
Our philosophy is rooted in helping patients lead full, meaningful lives. In most cases, we don’t recommend restricting lifestyle activities after diagnosis. Most daily activities are safe and encourages, including flying on an airplane, playing sports, and exercising. We provide personalized guidance based on your condition and goals.
AVMs can't go away on their own. However, there are surgical techniques that can treat or cure AVM.
Experts don't know what causes an AVM to form. It's believed that they usually form before or soon after birth, but the reason isn't clear.
Two significant risk factors for people with AVMs is high blood pressure and bleeding. We strongly recommend avoiding two specific behaviors that increase those risks: smoking and use of illicit drugs. These are important precautions for anyone, but especially for people with vascular conditions like AVMs or aneurysms.
Most daily activities are safe and encourages, including flying on an airplane and exercising.
An AVM itself is not a stroke, but it can cause one if it bleeds into the brain. Over time, the abnormal blood flow that happens as the result of an AVM can weaken the blood vessels, increasing the risk of rupture. This type of bleeding can cause a hemorrhagic stroke.
In fact, bleeding from a brain AVM is the most common cause of hemorrhagic stroke in young people adults.
To make an appointment, please call our program coordinator at 617-525-8128 or submit a request through our secure online form.
Neurosurgery
Neurosurgery
Neurosurgery
View the wonderful story of patient Nicole Haight and curing her brain arteriovenous malformation (AVM) by Neurosurgeon Nirav J. Patel, MD, and his team at Brigham and Women's Hospital.
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