Arteriovenous Malformations: Treatment

Also from Answers.com... Asthma How to prevent and treat an asthma attack.

More about Arteriovenous Malformations: Definition Causes and symptoms Diagnosis Treatment Prognosis Resources

Neurosurgeons consider several factors before deciding on a treatment option. There is some debate over whether or not to treat AVMs that have not ruptured and are not causing any symptoms. The risks and benefits of proceeding with treatment need to be measured on an individual basis, taking into account factors such as the person's age and general health, as well as the AVM's size and location. Several treatment options are available, both for symptomatic or asymptomatic AVMs. These treatment options may be used alone or in combination.

Removing the AVM is the surest way of preventing it from causing future problems. Both small and large AVMs can be handled in surgery. Surgery is recommended for superficial AVMs, but may be too dangerous for deep or very large AVMs. Unless it is an emergency situation, an AVM that has hemorrhaged is treated conservatively for several weeks. Conservative treatment consists of managing the immediate symptoms and allowing the patient's condition to stabilize. Surgery requires general anesthesia and a longer period of recuperation than any other treatment option.

Radiation is particularly useful to treat small (under 1 in) malformations that are deep within the brain. Ionizing radiation is directed at the malformation, destroying the AVM without damaging the surrounding tissue. Radiation treatment is accomplished in a single session and it is not necessary to open the skull. However, success can only be measured over the course of the following two years. A year after the procedure, 50-75% of treated AVMs are completely blocked; two years after radiation treatment, the percentage increases to 85-95%.

Embolization involves plugging up access to the malformation. This technique does not require opening the skull to expose the brain and can be used to treat deep AVMs. Using x-ray images as a guide, a catheter is threaded through the artery in the thigh (femoral artery) to the affected area. The patient remains awake during the procedure and medications can be administered to prevent discomfort. The blood vessel leading into the AVM is assessed for its importance to the rest of the brain before a balloon or other blocking agent is inserted via the catheter. The block chokes off the blood supply to the malformation. There may be a mild headache or nausea associated with the procedure, but patients may resume normal activities after leaving the hospital. At least two to three embolization procedures are usually necessary at intervals of two to six weeks. At least a three-day hospital stay is associated with each embolization.

— Julia Barrett