These lesions are surrounded by a very discrete layer of abnormal, nonfunctioning brain tissue, thus allowing their removal with relative safety from the surrounding brain. This factor is of the utmost importance to the brain surgeon, who can take advantage of this natural separation between normal brain tissue and the abnormal vascular malformation.
If it is a very small AVM, and it is deep seated in the brain, the patient is fortunate. It is possible to give focused beam radiation to the malformation, and avoid surgery. Within two years the malformation will most likely disappear.
Larger malformations may be made more surgically manageable with a technique called embolization. With this procedure an angiogram becomes a therapeutic tool. The interventional angiographer is capable of filling the malformation with agents that help decrease the blood supply to the malformation (coils, glues, plastic spheres, balloons, etc). This makes surgery easier in some cases. The technique has been used as a primary treatment as well, and has been successful in some cases.
Perhaps surgery is still the best way to go if the decision has been made to do something to eliminate the AVM for good. Surgery cures these lesions by totally removing them, thus preventing them from ever recurring again. The author’s personal bias is that most AVMs are best cared for with surgical removal. Even with patients who have large and complex srteriovenous malformations, surgery provides the cure when the malformation is completely removed.
Today, with the assistance of BrainLab’s most sophisticated equipment and computerized techniques, AVM removal has been greatly facilitated.
Leave It Alone
Some lesions, because of their size, location or behavior are best left alone. In these cases, your surgeon’s judgment is of the utmost import.
In other cases, courses of treatment may be determined by the age or medical condition of the patient. An example might be that of an AVM being found in a 70-year old woman suffering headaches after her heart surgery, having had no prior history of problems relating to the malformation. Another example might be the case of the 52-year old businessman with a very large and complex AVM located deep in the brain, involving the vessels that drain to the brainstem and/or speech areas of the brain.