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Arteriovenous Malformation (AVM) Resection

UPMC Content 3

An arteriovenous malformation (AVM) is abnormal, berry-like blood vessel patches in the brain. It's a congenital disease, meaning people are born with it.

UPMC is among the nation's largest, most experienced treatment centers for AVMs. Some treatments we use are microsurgical resection and Gamma Knife® radiosurgery.

What Is an Arteriovenous Malformation (AVM)?

An AVM is a group of blood vessels that have formed in an abnormal way.

The brain's arteries and veins connect in a way they shouldn't, creating a tangled mass of blood vessels. This changes the way blood flows in your brain.

An AVM is a condition you have from birth. You might not know that you have it because it doesn't always cause symptoms.

A large or growing AVM can put pressure on brain tissue and cause:

  • Confusion.
  • Dizziness.
  • Headaches.
  • Memory loss.
  • Muscle weakness or problems with coordination.
  • Numbness, tingling, or pain.
  • Seizures.
  • Vision or language problems.

Because blood vessels form abnormally in an AVM, they're not as strong. These arteries and veins may weaken or burst. When this happens, blood leaks into the brain.

How Do I Know If I Have an AVM?

You may learn you have an AVM when you have an imaging test or during treatment for another health issue.

If doctors suspect you have an AVM, they may order tests such as:

  • CT scan: computers take images that show the details of blood vessels in the brain.
  • MRI: magnets and a computer form detailed images of the brain's structure and tissues.
  • Cerebral angiogram: a thin tube (catheter) injects contrast dye into a blood vessel. The dye makes veins more visible on x-rays of the AVM's size and location.
  • Magnetic resonance angiography (MRA): contrast dye and an MRI machine show how blood flows in your brain.

When Do Surgeons Perform AVM Resection?

UPMC neurosurgeons may do resection microsurgery when an AVM bursts or starts to bleed into the brain. They may also operate on an AVM that's at serious risk of bursting.

When blood leaks into the brain, it can cause permanent brain damage or stroke.

Your neurosurgeon will talk with you about your risk of AVM rupture.

Before suggesting AVM resection, they'll assess:

  • Any symptoms you're having.
  • Your age and overall health.
  • The size and location of the AVM.

Is AVM Resection Right For Me?

AVM surgery isn't right for everyone.

Your neurosurgeon will talk with you about the benefits and risks of AVM resection.

UPMC neurosurgeons may suggest surgery after looking at your imaging test results to make sure:

  • The AVM is in a part of your brain that's easy to reach.
  • The AVM is not in a part of the brain that affects language, movement, reading, speech, or vision.
  • They can safely remove the AVM without damaging surrounding brain tissue.

In some cases, doctors may recommend treatments like radiation to help shrink the AVM. Reducing the AVM's size can make it safer to remove the mass.

AVM surgery offers some important advantages.

It corrects the AVM right away and removes the risk of rupture and brain bleeding.

AVM Resection: What To Expect

AVM resection involves delicately separating the AVM from the surrounding tissue.

Using a microscope, a UPMC neurosurgeon cuts off the blood supply to the AVM and removes it.

To prepare for AVM surgery, a member of your care team will:

  • Clean your scalp.
  • Give you medicine to put you to sleep during the surgery (general anesthesia).

Your neurosurgeon will first create an opening in your skull. A surgery that involves opening the skull is a craniotomy.

When the skull is open, the surgeon will:

  • Look through a powerful microscope to see details of the AVM's blood vessels.
  • Use tiny instruments to precisely remove the AVM.
  • Use imaging equipment to confirm that they've completely removed the AVM.
  • Reattach bone to the skull with a thin piece of metal and stitch the incision in your scalp.

You'll stay in a recovery room while you wake up from anesthesia.

Your care team will check your:

  • Blood pressure.
  • Breathing.
  • Heart rate.

They'll also talk with you to check your brain function. They make sure you can speak, understand, and respond to commands. After the recovery period, you may move to the ICU where doctors will watch you closely.

The size and location of the AVM — and whether you experienced any brain bleeding — may affect your recovery after surgery.

During your hospital stay, someone from UPMC neurorehabilitation may visit you to see if you may benefit from:

  • Occupational therapy.
  • Physical therapy.
  • Speech and swallowing therapy.

AVM Resection Recovery

As with any surgery, your body needs time to heal after AVM resection. You'll likely spend a few days in the hospital to make sure you're recovering as you should.

When you go home, it's vital to take things slowly at first.

During the first few weeks, it's normal to have:

  • Numbness, itching, soreness, or swelling at the incision site.
  • Bruising or swelling near your eyes.
  • Tiredness (fatigue).

Your neurosurgeon will talk with you about what to expect after surgery.

At first, you'll need to:

  • Get plenty of rest.
  • Walk a little each day.
  • Get up slowly when you rise from a chair or bed.
  • Avoid heavy lifting or strenuous activity until your doctor says it's safe.

Talk to your doctor about when you can resume work or exercise. Follow their instructions and let them know if you have any new symptoms or don't feel well.

Other AVM treatments

Your doctor may suggest other AVM treatments in addition to — or instead of — AVM resection.

These treatments include:

Surgeons thread a catheter through an artery in your groin to your brain. They inject a sticky substance through the catheter and into the AVM. This substance stops blood from flowing to the AVM and helps prevent bleeding.

Learn more about embolization.

This outpatient radiation treatment isn't really surgery. Doctors precisely target the AVM with focused radiation to shrink the mass. They may use this treatment when AVMs are in parts of the brain that make surgery too complex or impossible.

Learn more about Gamma Knife® radiosurgery.

Doctors may prescribe certain medications if an AVM causes symptoms. These include drugs that help control seizures and manage headaches.

Find AVM Support at UPMC

When you or someone you love has an AVM, we can connect you with others to help you cope.

Join us at an upcoming Aneurysm and AVM Support Group meeting.

Trust UPMC With Your AVM Resection

UPMC neurosurgeons are experts in diagnosing and treating AVMs. We offer several treatment options to give you the best chance for a cure.

Contact the UPMC neurosurgery team to learn more about how we treat AVM or to make an appointment.

Or call us at 412-647-3685 or 1-877-320-8762 (outside the U.S.).

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