How is an arteriovenous malformation (AVM) treated?

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Rafael Alexander Ortiz
Neurosurgery

A brain AVM can present in several different ways. Some brain AVMs present with bleeding in the head, others present with headaches, seizures, neurological signs (i.e. weakness), and others present incidentally (i.e. an MRI of the brain done for another reason showed a brain AVM). 

The management and treatment of a brain AVM will depend on the age of the patient, the presenting symptoms and signs, and how easy or difficult it is to treat the AVM (i.e. size and location within the brain).

Some AVMs are managed conservatively, but others will need intervention to prevent bleeding in the head, seizures, and/or worsening of neurological symptoms. Interventions for AVMs include:

  1. Endovascular embolization- Injection of liquid adhesives (i.e. glue and/or Onyx) through catheters that are navigated from a small incision in the groin region (femoral artery) to the area of the AVM in the brain.
  2. Surgery- Craniotomy (brain surgery) to remove the AVM.
  3. Radiation- Less invasive modality but it does not cure the AVM immediately as it takes some time to have its maximum final effect.

Some AVMs may need treatment with several of the intervention modalities in order to achieve the final goal.