Arteriovenous Malformation - Cerebral

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Treatment

A bleeding arteriovenous malformation is a medical emergency and requires immediate hospitalization. The goal of treatment is to prevent further complications by limiting bleeding, controlling seizures and, if possible, removing the AVM.

Treatment is usually required. Open brain surgery, endovascular treatment, and radiosurgery are some of the treatments used. Often these treatment options will be used in combination. Very large AVMs may short-circuit blood flow enough to cause cardiac decompensation in which the heart is unable to pump enough blood to compensate for bleeding in the brain. In this case, the condition is usually identified in infants and young children.

Surgery is dependent upon the accessibility and size of the lesion and the status of the patient at the time of surgery. Open brain surgery is the actual removal of the malformation in the brain through an opening made in the skull. It must be done by a highly skilled vascular neurosurgeon. This surgery is particularly risky because there is a chance that the surgery itself will cause the AVM to bleed uncontrollably and thereby produce more damage than was prevented.

Embolization (injecting a glue-like substance into the abnormal vessels to stop abherrant blood flow into the AVM) may be an alternative if surgery is not feasible because of size or location of the lesion. Stereotactic radiosurgery may be another alternative treatment for inoperable arteriovenous malformations. It is particularly useful for small deep lesions which are difficult to remove by surgery.

Diagnosis of a cerebral AVM may be made prior to a catastrophic hemorrhage because of recurrent headaches. Early diagnosis is preferable to diagnosis following a catastrophic hemorrhage, which can be fatal or severely disabling. However, since treatment can also be risky, treatment decisions must be made with great care for AVM.

Anti-convulsant medications, such as phenytoin, are usually prescribed if seizures occur.