There are three major treatment methods that may be useful either alone or in combination to treat an AVM. The specific treatment for an individual is based on the patient’s history, symptoms, and anatomy of the AVM including its size, feeding arteries, draining veins, and location within the brain.
ENDOVASCULAR SURGERY- Endovascular embolization for permanent occlusion or preoperative
In this procedure, a small catheter is threaded from the groin directly into the AVM vessels within the brain. Under X-ray guidance, embolic agent is injected through the catheter to permanently block and close off the vessels of the AVM. Materials most commonly used are glue – NBCA, and Onyx – glue like substance.
Embolization of an AVM is usually performed before treatment by either radiosurgery or open surgery. Embolization is often able to decrease the size of the AVM making the radiosurgery or surgery much safer than would otherwise be the case.
However, the blood flow from certain AVM’s may be totally blocked by embolization techniques, and no further therapy may be required.
RADIOSURGERY
Gamma Knife Radiosurgery is a technique which uses focused beams of radiation to treat AVMs that are sufficiently small and located in appropriate areas of the brain. Despite the name, no opening of the skull is required. Instead, the radiation causes scarring in blood vessels of the AVM, thereby eliminating it. After treating the AVM with radiosurgery, a period of two to three years is required for the full effect of the treatment to be determined.
OPEN SURGERY
Open surgical treatment involves removing a portion of the skull so that surgical instruments can be inserted to remove the AVM. Surgical treatment is often performed after embolization has closed portions of the AVM. The combination of embolization followed by surgical resection is frequently safer than surgical resection alone in treating an AVM.
