An AVM (arteriovenous malformation) is an abnormal connection between blood vessels, usually in the brain. An AVM causes blood to flow directly from high-pressure arteries to low-pressure veins without supplying blood to normal tissues.
Brain AVMs can cause devastating damage when they hemorrhage (bleed) or rupture. Treating an AVM is not always necessary. However, when an AVM hemorrhages, there are several treatments to stop the bleeding and prevent another hemorrhage.
At Barnes-Jewish Hospital, our team includes neurosurgeons, neurointerventional surgeons and other specialists who are leaders in treating AVMs in ways that lower the risk of rupture and cure the AVM. We collaborate to create a plan for AVM treatment that is tailored to your specific needs.
Your treatment depends on the size and location, or the complexity, of the AVM. High complexity doesn’t increase the risk of bleeding, but it does increase treatment risks. Barnes-Jewish is able to combine procedures and treat these AVMs with a high success rate.
As we see over half of the AVM patients in the St. Louis region each year, we have unparalleled experience. We are considered a high-volume neurological center, which is shown to provide a safer procedure and faster recovery for our patients. We also offer intraoperative angiography, which is the use of blood vessel X-rays during neurosurgery, to enhance your AVM treatment outcome.
Request a call to schedule an appointment with a Washington University neurosurgeon at Barnes-Jewish Hospital.
Medical Therapy & Monitoring
Sometimes the best strategy is to monitor the AVM if symptoms are not severe or the AVM is discovered later in a person’s life. If there are few symptoms or the AVM’s location makes it difficult to treat, your doctor might recommend medicine to control symptoms, such as seizures and headaches. You will also need to control your blood pressure and avoid blood thinners. Your neurovascular specialist will keep a close eye on the AVM with regular follow-up exams.
During AVM embolization, a small, flexible tube, or catheter, is inserted through the groin and guided up to the brain vessels and into the AVM. A non-reactive liquid, or glue-like material, is injected into the AVM. The adhesive material hardens and blocks the blood flow through the AVM.
Our neurosurgeons and neurointerventional surgeons often recommend AVM embolization prior to other treatment options to reduce the size of the AVM and make it more responsive to radiosurgery or suitable for surgical removal.
Radiosurgery for AVMs—known as stereotactic radiosurgery—is a type of radiation therapy. It involves focusing small, highly precise doses of radiation into the AVM. This slowly shrinks and destroys abnormal blood vessels.
AVM radiosurgery is effective for small AVMs and those that have not caused a life-threatening hemorrhage. It is also useful to treat AVMs that would be difficult to remove surgically. Barnes-Jewish Hospital commonly uses Gamma Knife radiosurgery as a safe way to treat AVMs. Barnes-Jewish has the only Gamma Knife in the St. Louis region.
AVM Surgery (Resection)
Because AVMs have a higher risk for bleeding, a neurosurgeon may also recommend removal or resection with surgery if they believe the AVM is favorable. Only some AVMs are safe for operation, depending on the size and location within the brain.
A neurosurgeon will open a portion of the skull (craniotomy) to see the AVM and remove the AVM from the surrounding brain tissue. Surgically removing the AVM cures the patient immediately, and the risk of bleeding is eliminated. Advanced imaging with intraoperative angiography, a catheter-based picture of blood vessels during the operation, is used to confirm complete removal of the AVM.
Talk to your neurosurgeon about whether you can have a hair-sparing surgery, which is where the incision is hidden in the hairline, allowing for a faster cosmetic recovery.
To make an appointment with a Washington University neurosurgeon at Barnes-Jewish Hospital, call 888.994.2545.