Treatment of AVMs

Explains medical, surgical, radiosurgical, and endovascular treatment options for arteriovenous malformations.

The treatment of brain arteriovenous malformations (AVMs) depends on several factors, including the AVM’s location and size, and whether it has caused bleeding.

Medical Treatment

Anticonvulsant medications, such as phenytoin, are used to control seizures. Other medications or procedures can be employed to relieve pressure inside the skull caused by the AVM. Curative treatment may eventually be required to prevent haemorrhage. However, all interventions carry some risk of causing neurological deficits.

Endovascular Treatment

Embolisation is a treatment approach performed by specialists known as interventional neuroradiologists. This procedure involves injecting substances into the blood vessels feeding the AVM to block them, reducing blood flow to the AVM. These substances are delivered via a catheter guided by real-time imaging. Benefits include the minimally invasive nature of the treatment and the immediate effect compared with radiosurgery. Endovascular therapy can also access areas of the brain that would be high-risk surgically. The cure rate depends on the type of AVM, however, and not all AVMs are treated endovascularly as first-line therapy. Embolisation may also be used as an additional treatment before surgery or radiosurgery to reduce AVM size.

Surgical Treatment

Surgical removal of the involved blood vessels is a good option for many types of AVMs. In this procedure, a neurosurgeon temporarily removes part of the skull (craniotomy), separates the AVM from the surrounding brain tissue, and removes (resects) the abnormal vessels. This method can result in immediate, complete removal of the AVM, but the risks depend on the size and location of the malformation. Not all AVMs are suitable for surgical treatment, and the decision depends on several factors, including the AVM’s size, location, and the patient’s overall health.

Radiosurgical Treatment

Radiosurgery, such as Gamma Knife therapy, can successfully treat small and medium-sized AVMs. This method precisely delivers controlled doses of radiation to the AVM area in the brain. While radiosurgery does not require an incision or craniotomy, it may take three or more years to fully assess the treatment’s effects, during which time there is still a risk of bleeding. Some patients may need repeat treatments. Radiosurgery can also carry risks such as headache, seizures, or permanent neurological deficits.