Treatment  

It is important that anyone facing the prospect of treatment make an informed choice. Remember your neurologist / neurosurgeon is human too and will understand you asking for a little time to discuss your options. There is a lot to consider but it is vital not to lose your head; trust the professionals.

An AVM is an abnormal tangle of blood vessels which have weakened walls. These abnormal blood vessels have a tendency to bleed. Treatment is recommended to protect against bleeding from the AVM in the future. If a bleed occurs it may damage the surrounding brain tissue and lead to stroke, permanent disability or even death. Approximately 4 people out of every 100 people with an AVM will experience a bleed each year.

The risk of disability from a bleed can be as high as 40% and the risk of dying from a bleed is about 10%. This is why treatment is so important. AVMs may also produce headaches, seizures and progressive paralysis, and treatment may alleviate these symptoms.

What is the risk of bleeding over my lifetime?    

The risk of bleeding over ones lifetime may be high; especially if the AVM is discovered in a young person.

Example: A 40 year old is found to have an AVM. The risk of their AVM bleeding over the next 40 years is over 80%. That is the cumulative risk of bleeding over his/her lifetime.

Treatment options Available           

There are several options available; the nature of treatment offered will depend on the size and location of the AVM. Your neurosurgeon will advise you of the most suitable options.

Embolisation: is a technique which involves injecting liquid glue or coils into the AVM, using a catheter similar to the one used for an angiogram.

Radiation/Stereotactic Surgery: is also known as Gamma Knife Surgery. The treatment involves narrow x-ray beams being focused on the AVM in such a way that a high dose is concentrated on the AVM with a much lower dose delivered to the rest of the brain. 

Surgery: is the traditional technique used to remove an AVM. It is often referred to as a craniotomy. This procedure is carried out by a neurosurgeon who will remove the AVM under general anaesthetic in theatre. 

Observation: can be used as a fourth option and may be recommended if the neurosurgeon feels that treatment cannot be offered safely or when an AVM is discovered in later life. 

 Will all of my symptoms be cured by treatment of the AVM?             

Treatment of an AVM is directed toward preventing brain injury, including that which may occur as result of a bleed; to date no treatment currently exists that can repair damage already caused to the brain by an AVM. Seizures may continue after embolisation or even complete removal of an AVM. Patients with neurological deficits resulting from an AVM or haemorrhage are likely to still have the deficits after treatment; although improvement can occur.

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