Overview
What Are Avms ?
An Arterio-Venous Malformation, or AVM is an abnormal collection of blood vessels. Normally, red oxygenated blood is pumped by the heart through branching tubes called arteries to the brain where it enters a fine network of tiny vessels called capillaries. It is in these capillary beds where the blood nourishes the tissues. Blue, deoxygenated blood then passes back to the heart back through branching thin walled tubes called veins. Arterial-Venous-Malformations are areas that lack the tiny Capillaries. The location of the connection between the artery and the vein is called the shunt. The area of tissue is called a nidus of the AVM. An AVM can be thought of as a "Short Circuit" where the blood does not go to the tissues but is pumped through the shunt and back to the heart without ever giving nutrients to the tissues.
What Causes Avms ?
We don't know what causes most AVMs. People are born with AVMs, although they do not appear to inherit them from their parents nor do they give them to their children. It appears that AVMs may be caused by a rupture or clotting of a blood vessel that happens during development before one is born. It is usually not associated with either other maldevelopments or with other AVMs.
Is There Any Treatment ?
Medication can often alleviate general symptoms such as headache, back pain, and seizures caused by AVMs and other vascular lesions. However, the definitive treatment for AVMs is either surgery or focused irradiation therapy. The decision to perform surgery on any individual with an AVM requires a careful consideration of possible benefits versus risks.
Treatment Options
Radiation
If there is a very small AVM, and it is deep seated in the brain, the patient is fortunate. It is possible to give focused beam radiation to the malformation, and avoid surgery. Within two years the malformation will most likely disappear.
Embolization
Larger malformations may be made more surgically manageable with a technique called embolization. With this procedure an angiogram becomes a therapeutic tool. The interventional angiographer is capable of filling the malformation with agents which help decrease the blood supply to the malformation (coils, glues, plastic spheres, balloons, etc). This makes surgery easier in some cases. The technique has been used as the primary treatment as well, and has apparently been successful in some cases.
Surgery
Perhaps surgery is still the best way to go if the decision has been made to do something to eliminate the AVM for good. Surgery cures these lesions by totally removing them, thus disallowing them from ever recurring again. The author's personal bias (quite strongly held) is that most AVM's are best cared for with surgical removal. Even with patients who have large and complex AVM's, surgery provides the cure when the malformation is completely removed.
Today, with the assistance of BrainLab's most sophisticated equipment and computerized techniques, an AVM removal has been greatly facilitated.
Here are two phases of an AVM removal:
- AVM Removal Part 1
- AVM Removal Part 2
How Is The Diagnosis Made ?
AVMs can be seen on outpatient imaging studies such as CT's or MRI's. Angiograms are inpatient procedures needed to image the arteries and veins before any treatment. An angiogram is a x-ray movie of the blood flowing through the blood vessels. It is made by injecting contrast into the arteries going into the head and taking a series of x-rays films.
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