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Treatments and drugs
By Mayo Clinic staffTreatment options for brain AVM involve a number of procedures and depend on the size and location of the abnormal blood vessels. Medications may also be used to treat related symptoms, such as headaches or seizures.
Surgical removal (resection)
Surgical treatment of a small brain AVM is relatively safe and effective. A section of skull is removed temporarily to gain access to the AVM. The neurosurgeon, aided by a high-powered microscope, seals off the AVM with special clips and carefully removes it from surrounding brain tissue. Sometimes this is done with a laser. The skull bone is then reattached, and the scalp is closed with stitches.
Resection is usually done when the AVM can be removed with acceptable risk to prevent hemorrhage or seizures. AVMs that are in deep brain regions carry a higher risk of complications. In these cases, other treatments are considered.
Endovascular embolization
During this procedure, a long, thin tube called a catheter is inserted into a leg artery and threaded through the body to the brain arteries. The catheter is positioned in one of the feeding arteries to the AVM, and small particles of a glue-like substance are injected to block the vessel and reduce blood flow into the AVM.
Endovascular embolization may be done alone, before other treatments to reduce the size of the AVM, or during surgery to reduce the chance of bleeding during the operation. In some large brain AVMs, endovascular embolization may reduce stroke-like symptoms by redirecting blood back to normal brain tissue.
Stereotactic radiosurgery
This treatment uses precisely focused radiation to destroy the AVM. The radiation causes the AVM vessels to slowly clot off in the months or years following the treatment. This treatment works best for small AVMs and for those that have not caused a life-threatening hemorrhage.
- Chung CS, et al. Stroke and other neurovascular disorders. In: Goetz CG. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa.: Elsevier Saunders; 2007. http://www.mdconsult.com/das/book/body/113422743-8/782331384/1488/384.html#4-u1.0-B978-1-4160-3618-0..10045-1--s0670_3824. Accessed Dec. 11, 2008.
- Arteriovenous malformations and other vascular lesions of the central nervous system fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/avms/detail_avms.htm. Accessed Dec. 11, 2008.
- Higashida RT. What is an arteriovenous malformation (AVM)? American Stroke Association. http://www.americanheart.org/downloadable/stroke/1095279678689What_Is_an_Arteriovenous_Malformation_Final%20Science%20review%206-03-03%20vF3.pdf. Accessed Dec. 11, 2008.
- Singer RJ, et al. Brain arteriovenous malformations. http://www.uptodate.com/home/index.html. Accessed Dec. 11, 2008.
- Aminoff MJ. Nervous system disorders. In: McPhee SJ, et al. Current Medical Diagnosis and Treatment. New York, N.Y.: The McGraw-Hill Companies; 2009. http://www.accessmedicine.com/content.aspx?aID=12814. Accessed Dec. 11, 2008
