Arteriovenous malformations are rare and it is even rarer for an AVM to cause serious problems. Most remain undetected and cause no obvious problems. An AVM may only need to be treated if it is large and bleeds or causes fits, seizures or other symptoms.
Blood vessel surgery is used to either remove an AVM, or to destroy the unstable blood vessels within it:
Open brain surgery involving a craniotomy (where the skull is opened to gain access to the brain) is used in cases where the AVM can be accessed relatively easily.
Microsurgical techniques are used to remove the AVM, reducing its blood supply. Brain angiography is then used to check the blood flow through the blood vessels that are left to ensure that the AVM is completely gone.
If the AVM is deep within the brain, an option for smaller AVMs is to use stereotactic radiosurgery. The CyberKnife® can be used to direct radiation at the tangle of blood vessels in the AVM causing them to shrivel and close over the following months.
Larger AVMs that are inaccessible can be treated using endovascular embolisation. This involves introducing a sealant substance into the AVM using a catheter introduced via a leg artery.
The arteries leading to the AVM are sealed and start to shrink after the procedure. The AVM is monitored using MRI scans and brain angiography and once the AVM has shrunk, symptoms usually improve. The smaller AVM may then be treated using the CyberKnife®.
Haemorrhagic stroke and other vascular problems
Haemorrhagic stroke caused by a ruptured brain aneurysm or AVM is treated as described above. It is also possible to have a haemorrhagic stroke because you have blocked carotid arteries in the neck or in the arteries that take blood into the brain tissue.
Surgery may be required after a haemorrhagic stroke to relieve pressure on the brain and stop the bleeding. Blocked arteries can be unblocked by using several different techniques; surgery to remove the atherosclerotic plaque is called an endarterectomy.
Other conditions treatable by blood vessel surgery at The London Clinic include:
- Subarachnoid haemorrhage: most cases are treated by a combination of bed rest and drug treatment and if digital subtraction angiograms show that the subarachnoid haemorrhage is due to a brain aneurysm or other blood vessel abnormality, then surgical treatment is performed as described above.
- Cavernomas: these are collections of expanded blood vessels that cluster together in globules. Where necessary, cavernomas are removed using conventional surgery.