Treatment of an AVM is focused on preventing bleeding and improving the patient’s quality of life. There are a few options, and sometimes they are used in combination:
- Microsurgical Removal (Resection): If an AVM is in a favorable location, a neurosurgeon can perform an open brain surgery to carefully remove the tangle of vessels. This immediately eliminates the AVM. In fact, surgical removal is often the first choice for smaller AVMs or those causing symptoms, because once completely removed, the AVM is considered cured.
- Endovascular Embolization: This is a minimally invasive procedure where a catheter is navigated into the AVM and special glue-like substances or coils are injected to block blood flow into the tangle. Embolization can shrink the AVM or reduce blood flow, making subsequent surgery safer or occasionally obliterating the AVM if it’s small. It’s often used as a pre-surgical or pre-radiation adjunct, though in some cases, a series of embolizations can significantly reduce an AVM.
- Radiosurgery (Gamma Knife or similar): For smaller AVMs or those deep in the brain, a focused radiation treatment can be used. Highly focused beams of radiation cause the AVM vessels to scar and close off over time (typically 1–3 years). This is all done without any incision. Radiosurgery has a high success rate for appropriately sized AVMs, but it works gradually, and there is a risk the AVM could bleed in the meantime before it fully closes.
Often, a combination is employed – for example, an AVM might be embolized first to reduce its size, then surgically removed; or partially embolized and then treated with radiosurgery. The approach depends on the AVM’s size, location, and the patient’s overall condition. Dr. Murali and the team will discuss the best plan in your case. The ultimate goal is to completely eliminate the AVM or at least block it off so that it cannot bleed with as low risk as possible.
