AVM Treatments
Observation
Observation is when no direct action is taken. Your surgeon considers it safer to monitor the AVM than attempt other invasive procedures. AVMs are congenital, meaning that people are born with them. If an AVM has not caused problems for the patient and is not likely to cause problems during the patient's expected life span, then observation may be a sound course of action, given that any treatment option carries some risk. Treatment should only occur if the risk of treatment is lower than of leaving the AVM alone.
Surgery
Surgical treatment procedures for AVMs include excision, clipping and coiling. When treatment of an AVM is warranted and surgery is feasible, it is recommended. The alternative treatment of radiosurgery takes several years to work, during which the AVM could bleed.
Microsurgical excision
Surgical removal of a brain AVM is a serious and delicate operation involving craniotomy (the opening of the skull). The risk of a major complication from surgery depends on the size and location of the AVM and the skill of the neurosurgeon.
Clipping
The neurosurgeon opens the skull and delicately separates the AVM from the surrounding tissue. A small titanium clip, which opens and closes like a clothespin, is then placed across the base of the AVM. Once the clip is secured, blood can no longer flow in or out of the AVM. By using a needle to drain the remaining blood out of the AVM, it should empty and eventually collapse.
Coiling
Also known as endovascular therapy, coiling is an innovative, less invasive surgical treatment option. This procedure does not involve craniotomy (the opening of the skull) and is performed from inside the blood vessel. A catheter is inserted into the patient's groin area and guided up toward the brain. A fine wire is then threaded into the catheter and directed into the AVM. Once inside the AVM, the wire twists into small coils and continues filling the AVM until it eventually clots off.
Radiosurgery
Our CyberKnife Center provides patients with breakthrough technology in AVM treatment. High-dose, focused radiation can be used to treat brain AVMs in a technique known as stereotactic radiosurgery. The procedure is not actual surgery and does not involve opening of the skull. The radiation must be delivered in a high dose to be effective, and the beam must be focused precisely on the AVM to avoid damage to surrounding normal brain tissue. Radiosurgery works slowly to cause the AVM to obliterate. After the radiation is given, it may take several years for the AVM to disappear. This means that there is some risk of bleeding while the radiation is working. One risk of radiation is injury to normal brain tissue around the AVM. This can result in neurological deficits such as weakness or paralysis, numbness, speech trouble, vision loss, etc. Not all AVMs respond to radiation. In particular, larger AVMs are less responsive to radiosurgery than smaller ones.
