Brain AVMs with NSPC’s Dr. Michael Brisman

What Are Brain AVMs?

At NSPC, we treat many patients who have brain AVMs, usually with minimally invasive modalities.Brain AVMs, or arteriovenous malformations, are vascular abnormalities of the brain. When brain AVMs occur, they are usually present at birth. These abnormal tangles of blood vessels usually present in early adulthood, either with bleeding or with a seizure. We typically diagnose using an MRI, although AVMs can sometimes be seen on CT scans or angiograms. We grade brain AVMs based on their size and location. Also, brain AVMs can sometimes be associated with brain aneurysms, which carry their own associated risks.

Brain AVM Risks

The history of brain AVMs is that about 3% per year will bleed. Of these 3% of patients, about half will recover fully, while the others will suffer serious, even life-threatening, neurological problems. Also, the risk of bleeding again is about 6% for the first year and 3% each year thereafter.

When we diagnose a brain AVM, we may decide to observe the person clinically and follow the condition with MRIs. If necessary, other treatment options are also available.

Brain AVM Treatment Options

One treatment option, embolization, involves inserting a catheter into a leg artery, threading it through to the brain, and injecting materials to help clot off the AVM. Another option, Stereotactic Radiosurgery, when aimed at the AVM, may cause the abnormal blood vessels to clot off over time, usually two to three years. Once this happens, there is no more risk of bleeding. Alternatively, we may remove the AVM surgically.

Brain AVMs that are 4 to 4.5 centimeters or larger, or those found in elderly people or people with significant medical problems, I usually treat with observation only, including MRIs and clinical exams. Very small AVMs are usually treated with embolization. If a patient has a brain AVM on the surface of the brain on a non-sensitive area and has had a bleed, and if a patient is younger and healthier, I recommend removing the brain AVM surgically after embolization. For most other brain AVMs, I recommend Stereotactic Radiosurgery with Gamma Knife treatment.

Stereotactic Radiosurgery for AVMs is a one-day, super-focused radiation treatment that will most often cure the AVM and cause all of its blood vessels to clot off. If, after several years, the brain AVM is still present, we can repeat the treatment.

There are many different brain AVM treatment options, and most of the time, they can be treated with minimally invasive techniques. At NSPC, we are always happy to answer any questions or concerns you might have.