Treating an Arteriovenous Malformation (AVM)
It is important to get medical attention for an AVM as soon as possible. Often, immediate treatment may help avoid serious complications of some AVMs. Current surgical methods make treatment for AVM safer and more effective than ever. The goal of treatment is to stop the flow of blood within the AVM and to prevent it from re-bleeding.
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Your healthcare team
The members of your healthcare team guide you through your treatment, support you, and answer your questions. Your team may include the following specialists:
· A neurosurgeon is a healthcare provider who performs the procedure needed to correct your problem.
· A radiologist is a healthcare provider who specializes in the use of radiation in the diagnosis and treatment of disease.
· A neurologist helps co-manage the person during the acute phase of illness, helps direct recovery therapy, and helps manage complications such as seizures.
· Nurses provide patient care and may also teach family and friends to assist with your recovery.
· Physiatrists (healthcare providers specializing in rehabilitation) assist in directing the recovery of lost motor and language skills.
· Physical and occupational therapists help with walking, dressing and other life skills.
· Speech therapists focus on speech and swallowing problems.
· A case manager or social worker helps guide you through the healthcare system and directs you to services that you may need after your hospital stay.
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Surgery for AVM
Surgical resection removes the tangled blood vessels.
- Reaching the brain. The surgeon uses a procedure called craniotomy to reach the brain. During a craniotomy, small holes called burr holes are made in the skull. The bone between the holes is cut and lifted away. Finally, the surgeon opens the dura, the layer over the brain, and exposes the brain.
- Removing the AVM. Once the surgeon has access to the AVM, the abnormal arteries and veins are removed. This redirects blood flow to normal vessels, preventing the AVM from bursting and leaking blood.
- Closing the skull. When the AVM has been removed, the dura covering the brain is closed. In most cases, the skull bone is put back. The skull bone can be held in place using one of several methods. Titanium clamps are often used, as they provide the most stability and cover the burr holes. After the clamps are in place, the skin incision is closed with stitches or staples.
Other treatments
AVMs sometimes require a combination of treatments. Other treatments include:
- Radiosurgery. Radiation (beams of gamma rays) can be directed at the AVM using tools called gamma knife, LINAC or proton beam. The irradiation delivered by the gamma knife closes off the abnormal blood vessels, so that blood no longer flows through them. Specialists (neurosurgeon, physicist, and radiation oncologist with special training in this field) will be involved.
- Embolization. Glue, beads, or coils (tiny, spring-shaped objects) may be inserted into the AVM through a catheter (very thin tube) that is passed through a blood vessel through the groin area up into the brain. This seals off the artery into the AVM to prevent further blood flow into the AVM. Embolization may happen in isolation or prior to surgical removal of the AVM. A specialist will be involved in embolization.