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 be required eventually to prevent hemorrhage. However, all interventions come with some risk of causing neurological deficits.
Surgical Treatment
Surgical removal of the involved blood vessels is a preferred treatment 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 an 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 status.
Radiosurgical Treatment
Radiosurgery, such as Gamma Knife therapy, can successfully treat small and medium sized AVMs. This method precisely delivers controlled radiation doses 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 know the treatment’s effects, during which time there’s still a risk of bleeding. Some patients may need repeat treatments. Radiosurgery can also have risks such as headache, seizures, or permanent neurological deficits.
Neuroendovascular Therapy
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. Embolisation is may be the primary therapy, or an additional treatment before surgery or radiosurgery to reduce the AVM size.