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WhatIsanArteriovenousMalformation(AVM)?

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WhatIsanArteriovenousMalformation(AVM)?
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1.3K Updated:Jun20,2014

AboutAVMs
SymptomsandBleeding
DiagnosisandTreatment
WhatisabrainAVM?
Normally,arteriescarrybloodcontainingoxygenfromthehearttothebrain,andveinscarrybloodwithless
oxygenawayfromthebrainandbacktotheheart.Whenanarteriovenousmalformation(AVM)occurs,atangle
ofbloodvesselsinthebrainoronitssurfacebypassesnormalbraintissueanddirectlydivertsbloodfromthe
arteriestotheveins.

HowcommonarebrainAVMs?
BrainAVMsoccurinlessthan1percentofthegeneralpopulation.Itsestimatedthataboutonein200500people
mayhaveanAVM.AVMsaremorecommoninmalesthaninfemales.
WhydobrainAVMsoccur?

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StrokeistheNo.5
causeofdeathinthe
U.S.Duringastroke,
partofthebraincannot
getthebloodand
oxygenitneeds,soit
startstodie.
Learnmoreaboutthe
typesofstrokeandhowtheyaffectyourbrain.

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WedontknowwhyAVMsoccur.BrainAVMsareusuallycongenital,meaningsomeoneisbornwithone.But
theyreusuallynothereditary.PeopleprobablydontinheritanAVMfromtheirparents,andtheyprobablywont
passoneontotheirchildren.
WheredobrainAVMsoccur?
BrainAVMscanoccuranywherewithinthebrainoronitscovering.Thisincludesthefourmajorlobesofthefront
partofthebrain(frontal,parietal,temporal,occipital),thebackpartofthebrain(cerebellum),thebrainstem,orthe
ventricles(deepspaceswithinthebrainthatproduceandcirculatethecerebrospinalfluid).

Whensomeonehasshownsymptomsofastroke
oraTIA(transientischemicattack),theyrequire
immediatemedicalattention.Adoctorwillgather
informationandmakeadiagnosisandbegina
courseoftreatmentdependingonthecauseofthe
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DobrainAVMschangeorgrow?
MostAVMsdontgroworchangemuch,althoughthevesselsinvolvedmaydilate(widen).SomeAVMsmayshrink
duetoclotsinpartoftheAVM.SomemayenlargetoredirectbloodinadjacentvesselstowardanAVM.
WhatarethesymptomsofabrainAVM?
SymptomsmayvarydependingonwheretheAVMislocated:

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15/1/2016

WhatIsanArteriovenousMalformation(AVM)?
Morethan50percentofpatientswithanAVMhaveanintracranialhemorrhage.
AmongAVMpatients,20percentto25percenthavefocalorgeneralizedseizures.
PatientsmayhavelocalizedpainintheheadduetoincreasedbloodflowaroundanAVM.
Fifteenpercentmayhavedifficultywithmovement,speechandvision.

conditions,treatmentsandproceduresrelatedto
heartdiseaseandstroke.
Startexploringtoday!

WhatcausesbrainAVMstobleed?
AbrainAVMcontainsabnormaland,therefore,weakenedbloodvesselsthatdirectbloodawayfromnormal
braintissue.Theseabnormalandweakbloodvesselsdilateovertime.Eventuallytheymayburstfromthehigh
pressureofbloodflowfromthearteries,causingbleedingintothebrain.

PopularArticles

TIA(TransientIschemicAttack)

WhatarethechancesofabrainAVMbleeding?

StrokeTreatments

ThechanceofabrainAVMbleedingis1percentto3percentperyear.Over15years,thetotalchanceofanAVM
bleedingintothebraincausingbraindamageandstrokeis25percent.

IschemicStrokes(Clots)

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(AVM)?

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Doesonebleedincreasethechanceofasecondbleed?
Theriskofrecurrentintracranialbleedingisslightlyhigherforashorttimeafterthefirstbleed.Intwostudies,the
riskduringthefirstyearafterinitialbleedingwas6percentandthendroppedtothebaselinerate.Inanotherstudy,
theriskofrecurrenceduringthefirstyearwas17.9percent.Theriskofrecurrentbleedingmaybeevenhigherin
thefirstyearafterthesecondbleedandhasbeenreportedtobe25percentduringthatyear.Peoplewhoare
between11to35yearsoldandwhohaveanAVMareataslightlyhigherriskofbleeding.
WhatcanhappenifabrainAVMcausesableed?
Theriskofdeathrelatedtoeachbleedis10percentto15percent.Thechanceofpermanentbraindamageis20
percentto30percent.Eachtimebloodleaksintothebrain,normalbraintissueisdamaged.Thisresultsinlossof
normalfunction,whichmaybetemporaryorpermanent.Somepossiblesymptomsincludearmorleg
weakness/paralysis,ordifficultywithspeech,visionormemory.Theamountofbraindamagedependsonhow
muchbloodhasleakedfromtheAVM.
WhatfunctionsdoesanAVMaffect?
IfanAVMbleeds,itcanaffectoneormorenormalbodyfunctions,dependingonthelocationandextentofthe
braininjury.Differentlocationsinthebraincontroldifferentfunctions:
Frontallobecontrolspersonality.
Parietallobecontrolsmovementofthearmsandlegs.
Temporallobecontrolsspeech,memoryandunderstanding.
Occipitallobecontrolsvision.
Thecerebellumcontrolswalkingandcoordination.
Ventriclescontrolthesecretionofcerebrospinalfluid.
Thebrainstemcontrolsthepathwaysfromalloftheabovefunctionstotherestofthebody.
AretheredifferenttypesofbrainAVMs?
Allbloodvesselmalformationsinvolvingthebrainanditssurroundingstructuresarecommonlyreferredtoas
AVMs.Butseveraltypesexist:
Truearteriovenousmalformation(AVM).Thisisthemostcommonbrainvascularmalformation.Itconsists
ofatangleofabnormalvesselsconnectingarteriesandveinswithnonormalinterveningbraintissue.
OccultorcrypticAVMorcavernousmalformations.Thisisavascularmalformationinthebrainthat
doesntactivelydivertlargeamountsofblood.Itmaybleedandoftenproduceseizures.
Venousmalformation.Thisisanabnormalityonlyoftheveins.Theveinsareeitherenlargedorappearin
abnormallocationswithinthebrain.
Hemangioma.Theseareabnormalbloodvesselstructuresusuallyfoundatthesurfaceofthebrainandon
theskinorfacialstructures.Theserepresentlargeandabnormalpocketsofbloodwithinnormaltissue
planesofthebody.
Duralfistula.Thecoveringofthebrainiscalledtheduramater.Anabnormalconnectionbetweenblood
vesselsthatinvolveonlythiscoveringiscalledaduralfistula.Duralfistulascanoccurinanypartofthe
braincovering.Threekindsofduralfistulasare:
Duralcarotidcavernoussinusfistula.Theseoccurbehindtheeyeandusuallycausesymptoms
becausetheydiverttoomuchbloodtowardtheeye.Patientshaveeyeswelling,decreasedvision,
rednessandcongestionoftheeye.Theyoftencanhearaswishingnoise.
TransverseSigmoidsinusduralfistula.Theseoccurbehindtheear.Patientsusuallycomplainof
hearingacontinuousnoise(bruit)thatoccurswitheachheartbeat,localpainbehindtheear,headaches
andneckpain.
Sagittalsinusandscalpduralfistula.Theseoccurtowardthetopofthehead.Patientscomplainofnoise
(bruit),headaches,andpainnearthetopoftheheadtheymayhaveprominentbloodvesselsonthescalp
andabovetheear.
Whatisthebesttreatmentforaduralfistula?
Thebesttreatmentisusuallyendovascularsurgicalblockingoftheabnormalconnectionsthathavecausedthe
fistula.Thisinvolvesguidingsmalltubes(catheters)insidethebloodvesselwithXrayguidanceandblockingoff
theabnormalconnections.Dependingonthelocationandsize,manyofthesecanbetreatedandcuredbythese
lessinvasiveendovasculartechniques.
HowareAVMsdiagnosed?
MostAVMsaredetectedwitheitheracomputedtomography(CT)brainscanoramagneticresonanceimaging
(MRI)brainscan.ThesetestsareverygoodatdetectingbrainAVMs.Theyalsoprovideinformationaboutthe
locationandsizeoftheAVMandwhetheritmayhavebled.Adoctormayalsoperformacerebralangiogram.This
testinvolvesinsertingacatheter(smalltube)throughanarteryintheleg(groin).Thenitsguidedintoeachofthe
vesselsintheneckgoingtothebrain,andacontrastmaterial(dye)isinjectedandpicturesaretakenofallthe
bloodvesselsinthebrain.ForanytypeoftreatmentinvolvinganAVM,anangiogrammaybeneededtobetter
identifythetypeofAVM.
WhatfactorsinfluencewhetheranAVMshouldbetreated?

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WhatIsanArteriovenousMalformation(AVM)?

Ingeneral,anAVMmaybeconsideredfortreatmentifithasbled,ifitsinanareaofthebrainthatcanbeeasily
treatedandifitsnottoolarge.
WhatisthebesttreatmentforanAVM?
Itdependsonwhattypeitis,thesymptomsitmaybecausinganditslocationandsize.
Whatdifferenttypesoftreatmentareavailable?
Medicaltherapy.Iftherearenosymptomsoralmostnone,orifanAVMisinanareaofthebrainthatcant
beeasilytreated,conservativemedicalmanagementmaybeindicated.Ifpossible,apersonwithanAVM
shouldavoidanyactivitiesthatmayexcessivelyelevatebloodpressure,suchasheavyliftingorstraining,
andavoidbloodthinnerslikewarfarin.ApersonwithanAVMshouldhaveregularcheckupswitha
neurologistorneurosurgeon.
Surgery.IfanAVMhasbledand/orisinanareathatcanbeeasilyoperatedupon,thensurgicalremoval
mayberecommended.Thepatientisputtosleepwithanesthesia,aportionoftheskullisremoved,andthe
AVMissurgicallyremoved.WhentheAVMiscompletelytakenout,thepossibilityofanyfurtherbleeding
shouldbeeliminated.
Stereotacticradiosurgery.AnAVMthatsnottoolarge,butisinanareathatsdifficulttoreachbyregular
surgery,maybetreatedwithstereotacticradiosurgery.Inthisprocedure,acerebralangiogramisdoneto
localizetheAVM.FocusedbeamhighenergysourcesarethenconcentratedonthebrainAVMtoproduce
directdamagetothevesselsthatwillcauseascarandallowtheAVMtoclotoff.
Interventionalneuroradiology/endovascularneurosurgery.Itmaybepossibletotreatpartorallofthe
AVMbyplacingacatheter(smalltube)insidethebloodvesselsthatsupplytheAVMandblockingoffthe
abnormalbloodvesselswithvariousmaterials.Theseincludeliquidtissueadhesives(glues),microcoils,
particlesandothermaterialsusedtostopbloodflowingtotheAVM.Thebesttreatmentdependsonthe
symptomsthepatientishaving,whattypeofAVMispresentandtheAVMssizeandlocation.
WhatdoctorsspecializeintreatingbrainAVMs?
VascularneurosurgeonsspecializeinsurgicallyremovingbrainAVMs.
Radiationtherapists/neurosurgeonsspecializeinthestereotacticradiosurgerytreatmentofbrainAVMs.
Interventionalneuroradiologists/endovascularneurosurgeonsspecializeintheendovasculartherapyof
brainAVMs.
StrokeneurologistsspecializeinthemedicalmanagementofbrainAVMs.
Neuroradiologistsspecializeinthediagnosisandimagingofthehead,neck,brainandspinalcord.Theyperform
andinterprettheCT,MRI,andcerebralangiogramsnecessaryforevaluation,managementandtreatment.Eachof
thesespecialistshashadadvancedtrainingandishighlyskilledattreatingcomplexbrainvascularmalformations.
Thiscontentwaslastreviewedon10/23/2012.

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