Treatment Options for Arteriovenuous Malformations
There are four treatment options in dealing with AVMs:
- Conservative management
- Stereotactic radiosurgery
- Surgery to remove the AVM
This means managing a person's symptoms with anti-seizure medications. This may be recommended for very old patients with unruptured AVMs, or very large AVMs that present high risks if treated any other way. The decision to treat an AVM by conservative measures should be made in coordination with a neurovascular specialist.
Stereotactic radiosurgery delivers a single, high dose or radiation in a precisely focused way. This procedure causes the blood vessels to thicken and close off over a period of time, as long as 18 months to two years.
Stereotactic radiosurgery may be advocated in certain AVMs which are small, typically less than 3 cm. Particularly if the AVM is in a deep location or if the patient is a poor candidate for surgery because of risks of anesthesia, etc.
Embolization is the injection of a glue-like material into the abnormal arteries to block them.
During this procedure, the neurovascular surgeon uses an angiogram to help him or her place a small tube in the arteries feeding the AVM. When the tube has been properly placed, the glue-like material is injected into the arteries.
This procedure is done to try to shrink an AVM before doing other treatments such as surgery or stereotactic radiosurgery. In rare cases, embolization may be used to eliminate a small AVM.
Surgical Removal of an AVM
Several factors are considered before an AVM is surgically removed. These include the size of the AVM, where it is located, how it is formed and its relationship to the arteries that feed the AVM and the veins that drain it. The patient's age and general physical condition are also taken into consideration in the decision-making process for surgical treatment.
Family Screening for AVMs
In most cases, AVMs of the brain and spinal cord develop spontaneously without a cause that can be identified. In these cases, there is no need for family screening. It is unlikely there is a genetic component.
There are exceptions, however. The rare disease Osler-Weber-Rendu syndrome appears to run in families. It causes arteriovenous fistula in the lungs and related brain malformations. Usually there is a history of family members who have the condition.
Treating Arteriovenous Malformations at the Neurovascular Center at Cedars-Sinai
At the Neurovascular Surgery Center, we offer the full spectrum of treatment options for arteriovenous malformations and the aneurysms that sometimes come with them. In addition, the Neurovascular Surgery Center has state-of-the-art approaches for dealing with complications of AVMS such as stroke, blood clotting in the brain and neurological problems resulting from AVMS.