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Arteriovenous Malformations (AVM)

What is an arteriovenous malformation (AVM)?

An arteriovenous malformation, or AVM, is an abnormal tangle of vessels in the brain or spinal cord in which one or more arteries are directly connected to one or more veins. Arteries carry blood from the heart to the tissues and veins take blood back from the tissues to the heart. In an AVM, the direct connection between one or more arteries and veins gives rise to many problems. The most serious problem is that veins are typically thin-walled vessels that cannot accept high-pressure blood flow for extended periods. The result is that AVMs can rupture and bleed into the brain.

Brain Arteriovenous Malformation (AVM) | William's Story

When William learned his headaches were caused by a complex AVM (arteriovenous malformation: an abnormal tangle of vessels in the brain) and multiple associated brain aneurysms, he traveled to The Johns Hopkins Hospital. After many delicate procedures over five months to block blood vessels of the AVM, followed by a major brain surgery to remove the tangle itself, William is now back living his life to the fullest. Watch his story.

 

Diagnosis of an arteriovenous malformation (AVM)

Johns Hopkins estimates that less than one percent of people are born with a brain or spinal cord AVM. Although AVMs are congenital (which means that patients are born with it), they are not usually hereditary (which means that they are not passed from parents to children). Most AVMs declare themselves by bleeding in adults younger than 40 years old. Some AVMs declare themselves by causing seizures or headaches. We typically find the AVM in a computed tomography (CT) scan or, more commonly, in a magnetic resonance imaging (MRI) scan. If the cerebrovascular team finds an AVM by CT or MRI, the team will then recommend an angiogram. An angiogram (also called arteriogram) is a special test in which a neuroradiologist injects dye into the blood vessels in the brain and obtains images of the blood vessels. At this point, the angiogram is the test that most accurately shows the AVM and its relationship to the surrounding arteries and veins.

Treatment for arteriovenous malformation (AVM)

The cerebrovascular team at Johns Hopkins evaluates each AVM patient to decide the best singular procedure or combination of treatments for the patient's specific AVM.

  • Microsurgical resection — This is the most established of the three techniques. During microsurgical resection, a neurosurgeon performs a craniotomy and removes the AVM from the brain or spinal cord using a microscope.
  • Stereotactic radiotherapy — A more recent technique for the treatment of AVMs, this is also known as stereotactic radiosurgery."During this treatment, the cerebrovascular team will deliver a concentrated dose of radiotherapy to the core of the AVM in one session. Over the course of two to five years, the vessels of the AVM clot off and the AVM shuts down.
  • Endovascular embolization — Another more recent technique for the treatment of AVMs, this treatment involves passing a catheter through the groin up into the arteries in the brain that lead to the AVM and injecting a material into these arteries. This injection shuts off that artery and reduces the flow of blood through the AVM. Endovascular embolization by itself typically does not eliminate the AVM and is therefore almost always used as a preliminary step in preparation for either microsurgical resection or stereotactic radiotherapy.

For more information, contact the Johns Hopkins Cerebrovascular Center at 410-955-2228.

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Maryland Patients

To request an appointment or refer a patient, please call:
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Neurosurgery: 410-614-1533

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Adult Neurology: 410-955-9441
Pediatric Neurology: 410-955-4259
Adult Neurosurgery: 410-955-6406
Pediatric Neurosurgery: 410-955-7337

 

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