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Arteriovenous Malformation (AVM) Management and Treatment

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On Topic Video Transcript

Robert M. Friedlander, MD

Chairman, Department of Neurological Surgery

A brain AVM or arteriovenous malformation is an abnormal conglomeration of blood vessels. One of the most critical components of managing a patient with an AVM is deciding whether this patient should be treated or not. And it’s dependent upon if the AVM itself is deemed to be a dangerous AVM or a not so dangerous AVM. In general there are three different ways that we treat AVMs. One is with surgery, we go in with a microscope in the operating room and resect, remove the AVM; the second is with endovascular embolization where we go in with a catheter all the way up to the AVM and we occlude the vessels that go into the AVM; and the third one is with radiosurgery. These techniques can be used either individually or in combination.

One of the ways of treating AVMs is with surgery, and with surgery we take the patient to the operating room, we do a small craniotomy where with a microscope I would go in and remove this AVM.  I coagulate each one of the little feeding arteries that goes into the AVM and we are able to completely remove it.  The advantage of microsurgical resection is that the AVM is cured immediately. By the time the patient leaves the operating room the AVM is cured.

Radiosurgery: The Gamma Knife®

L. Dade Lunsford, MD

Director, Center for Image-Guided Neurosurgery

The gamma knife is a technique that’s designed to slowly close an AVM without opening the head. It’s done with a technique where we crossfire x-ray beams from all around the head using a very precise guidance technique.  And our experience has been based now over 24 years and over 1,400 patients with this problem. What the focusing of the radiation does is to gradually get blood vessels that make up the AVM to thicken and shrink over time so that within perhaps three years we have a somewhere between 80 and 90 percent chance that a single treatment will get the AVM to slowly close. 

Embolization: Blocking the Blood Vessels

Michael B. Horowitz, MD

Head of Endovascular Therapy

The embolization procedure involves threading a small catheter up from the blood vessels of the groin up into the head over a very small wire, and then getting to those blood vessels in the brain that go to the AVM and injecting materials to block those blood vessels off so that there’s less blood flow to the AVM. And what that does is it makes it possible to cure the AVM possibly with just the embolization. That would work for small AVMs, and for larger AVMs it makes surgery safer and radiosurgery more effective.

A Team Approach

Dr. Friedlander

The key of our success in the management of AVMs is in the numbers. We’ve treated many, many AVMs.  People come from all over the world to Pittsburgh to have their AVMs treated, and part of this is that we meet as a team.  Every week we have conferences where we discuss patients with AVMs and we define which treatment is best for each patient. For some that might be radiosurgery, surgery, embolization or a combination of any of them. The key is to cure the AVM, for the AVM not to fill with any blood. And the key for us is for each patient who walks out of here is that they could say I had an AVM when they leave our unit. 

For more information, contact us at 412-657-3685.