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AVM – Treatment Options

AVM – Treatment Options

AVM Treatment at Orange County CyberKnife

Arteriovenous malformations (AVMs) are abnormal, snarled tangles of blood vessels that cause multiple irregular connections between the arteries and veins. While they are most common in the spinal cord and the brain, they can develop elsewhere in the body. It is unclear why AVMs form. Most often they are inherited, but they can sometimes appear sporadically. ATMs can cause seizures and severe headaches as well as muscle weakness, paralysis, dizziness, vision loss, back pain, confusion, and more. Most dangerously, AVMs can cause significant neurological damage and brain hemorrhaging. At Orange County CyberKnife, we offer a comprehensive selection of effective cancer treatments in Southern California, including AVM surgery and the world-class CyberKnife Radiosurgery System.

Symptoms of Arteriovenous Malformations

Depending on where the AVM forms, and how large it grows, symptoms can be incredibly varied. Seizures and headaches are two of the most common symptoms for AVMs occuring in the brain. Seizures may affect only the focal point of the brain, or they may affect the entire brain and result in the convulsions that are typically associated with seizures. Headaches may be as severe as a migraine, or very mild, showing no clear pattern of intensity, duration, or frequency. Other symptoms of AVM include:

  • Weak muscles or partial paralysis
  • Lack of coordination (ataxia) that may interfere with how a person walks
  • Difficulty with planning and executive function
  • In the case of a spinal AVM, back pain or pain in the lower parts of the body is common
  • Dizziness
  • Partial loss of vision, inability to control the eye, or a swollen optic nerve
  • Inability to understand language or difficulty speaking (aphasia)
  • Spontaneous and inexplicable pain, numbness, or other sensations
  • Problems with memory
  • Hallucinations, dementia, or general confusion
  • In some cases, an AVM can cause learning disabilities or behavioral disorders in childhood before other symptoms develop

If you experience any of the above symptoms, especially a combination of symptoms, see your doctor as soon as possible.

Types of Arteriovenous Malformations

Arteriovenous Malformations take many different forms. Each affects a different part of the brain and its surrounding structures. Patient symptoms will vary widely, as will treatment options, based on the type and location of the AVM. It’s important to remember that AVMs are not a progressive condition, and therefore do not have stage classifications. They are most often inherited, and sometimes patients are completely unaware of their condition due to not experiencing symptoms. Types of AVMs are classified as follows:

  • True Arteriovenous Malformation: The most common brain vascular malformation, this forms from a tangle of abnormal blood vessels that connect arteries and veins without normal brain tissue between them.
  • Occult or Cryptic AVM (Cavernous Malformations): This refers to an AVM in the brain that doesn’t divert large amounts of blood. However, these malformations may bleed or produce seizures.
  • Venous Malformation: This refers to an abnormality affecting only veins. Often, the veins may be enlarged or appear in abnormal locations within the brain.
  • Hemangioma: Usually occurring on the surface of the brain or on the skin or facial structures, these form as large pockets of blood within normal tissue in the body.
  • Dural Fistula: Dural fistulas occur within the “dura mater,” the hard outer covering of the brain that lies beneath the skull. Dural fistulas involve only abnormal connections between blood vessels in the dura mater, but they may take any one of three forms:
    • Dural Carotid Cavernous Sinus Fistula: This form occurs behind the eye, often causing symptoms from diverting blood away from the eye. Patients commonly experience swelling of the eyes, vision loss, redness, or congestion, and they may sometimes hear a “swishing” noise.
    • Transverse Sigmoid Sinus Dural Fistula: This type occurs behind the ear, often causing patients to hear a continuous noise (bruit) that occurs with each heartbeat. In addition, patients may experience a sensation of pain behind the ear, headaches, or neck pain.
    • Sagittal Sinus & Scalp Dural Fistula: These occur near the top of the head and can cause a number of symptoms. Patients may hear noise (bruit), have headaches, or pain near the top of the head, and they may also display overly prominent blood vessels on the scalp and above the ear.

Treatment Options for AVMs

There are several treatment options for patients with AVM, but each involves various risks depending on the individual. A hemorrhage from an untreated AVM can cause serious neurological damage or death, leading many specialists to recommend Arteriovenous Malformation surgery. However, surgery on any part of the central nervous system carries risk of serious complications or death. An AVM grading system developed in the mid-80s can help healthcare professionals estimate the risk of surgery based on the size of the AVM, location in the brain and surrounding tissue involvement, and any leakage. Treatment options include:

  • Medication. Although medicines can often lessen general symptoms, such as headache, back pain, and seizures, the definitive treatment for AVMs is either surgery or focused radiation therapy.
  • AVM Surgery – Arteriovenous malformation surgery involves entering the brain or spinal cord and removing the central portion of the AVM, including the fistula. This surgery is most recommended when an AVM is located in a superficial portion of the brain or spinal cord and is relatively small in size. AVMs located deep inside the brain generally cannot be approached through conventional surgical techniques, because there is too great a possibility that functionally important brain tissue will be damaged or destroyed.
  • Endovascular embolization – For this treatment, a surgeon guides a catheter through the arterial network until the tip reaches the site of the AVM, then injects a fast-drying, glue-like substance, (fibered titanium coils or a tiny balloon) that will travel through blood vessels and create an artificial blood clot in the center of the AVM. Since embolization usually does not permanently obliterate the AVM, it is typically used in conjunction with surgery or radiosurgery to reduce the flow of blood through the AVM and make surgery safer.
  • CyberKnife Radiosurgery – A non-invasive therapeutic approach often used to treat small AVMs that haven’t ruptured is radiosurgery, in which a beam of highly focused radiation is aimed directly on the AVM and damages the walls of the blood vessels making up the lesion. Orange County CyberKnife utilizes the newest technology in radiosurgery – the CyberKnife Radiosurgery System – to effectively treat AVMs. CyberKnife combines a flexible robotic arm with state-of-the-art imaging system to pinpoint the exact location of the AVM minimizing damage to surrounding tissue or organs. The flexibility allows CyberKnife to reach AVMs at hundreds of different angles. Over the course of the next several months, the irradiated vessels gradually degenerate and eventually close, leading to the resolution of the AVM.

Find Out More About CyberKnife Treatment & AVM Surgery

No matter what you’re facing, you can trust the cancer specialists at Orange County Cyberknife to stand by your side and help you overcome cancer to live a happy, healthy life. If you’d like to learn more about the CyberKnife Radiosurgery System and how it can treat your AVM, or if you have any questions regarding Arteriovenous Malformation surgery, we’d be happy to speak with you and ease your concerns. Just reach out to us by phone at (714) 962-7100, or fill out our convenient online appointment form. We look forward to hearing from you!