Cerebral Arteriovenous Malformations (AV M's) are congenital vascular lesions characterized by persistence of embryologic vessels, with abnormal arterial-venous flow across the AVM. AVM's predispose patients to bleeding in the brain, causing potentially fatal hemorrhage. AVM treatment needs to be tailored to the individual patient and often requires a multi-disciplinary approach. Treatments include endovascular embolization, surgery, or radiotherapy, or a combination of therapies.
Cerebral AVM’s are uncommon congenital vascular anomalies of the brain. While they may be completely asymptomatic, they often present as a source of seizures, due to scarring of the underlying brain parenchyma. More ominously, they can be the source of intracranial hemorrhage, and potentially fatal when they rupture. AVM’s hemorrhage at a rate of approximately 4% per year. They can also be associated with other abnormalities of the blood vessels such as aneurysms.
The treatment modalities for AVM include endovascular embolization, neurosurgical resection, and stereotactic radiosurgery. Treatment of these complex lesions is usually multimodal, with most AVM’s requiring a combination of two or all three treatment options.
At MMC, a multi-disciplinary team evaluates all patients with cerebral AVM’s and a plan of treatment is prescribed at our regular neurovascular conference. Embolization is usually performed first, in order to shrink large AVM’s prior to radiation therapy or prior to surgical resection. During embolization, a catheter is advanced through the arterial system into the brain, into the vessels supplying the AVM. A liquid embolic agent is used to obliterate the abnormal vessels at the center of the AVM, called the “nidus” of the AVM. Most AVM’s require staged embolization, with multiple treatments separated by several weeks. Recovery is usually quite rapid after each treatment, with short hospital stays.