Embolization of arteriovenous malformations

Treatment options

Several treatment options exist for AVMs of the brain. They can be used alone or in combination:

• Endovascular embolization: After a groin puncture, we access and treat the vascular malformation via the arteries and veins. During the procedure, we insert plastic tubes (catheters) through the femoral artery and into the AVM and inject an agent that occludes its blood vessels. Endovascular embolization is less invasive than traditional surgery. It can be used alone or as a supportive measure before surgery since it reduces the size of the AVM and decreases the likelihood of bleeding. As a supportive measure, it makes the succeeding operation safer.
• Surgical removal (resection): The AVM can be surgically removed in a neurosurgical procedure, with or without preoperative embolization.
• Stereotactic radiosurgery (SRS): During this intervention, radiation is precisely directed at the AVM. The radiation damages the blood vessels of the AVM, leading to scarring, and, as a consequence, to the  descrution of the AVM.
• Conservative treatment: As an alternative to invasive methods, conservative treatment (without surgery) is also considered. This is appropriate in cases where the risks of invasive treatment outweighs the natural risks of the disease.

Vascular malformation (arteriovenous malformation) in the blood vessels of the head. The AVM is visible as a vascular tangle.

Advantages and disadvantages

• Treatment of an AVM helps reduce the risk of brain damage from a hemorrhage or stroke. It also helps prevent re-rupture after a previous hemorrhage.
• However, complications can occur during treatment. These include: Cerebral hemorrhage during or after embolization and during microcatheter navigation or cerebral infarction due to occlusion of the normal cerebral vessels.
• The risks that come with an embolization treatment must be assessed individually for each patient. The attending physician will discuss them with the patient. The benefits and risks of treating the AVM are always evaluated by an interdisciplinary team of experts.

The course of treatment

Treatment starts with the diagnosis and the decision to use minimally invasive methods. After discussing this with you during a consultation, we will schedule a timely appointment, which is in keeping with the urgency of your case and your special wishes.

The treatment requires a hospital stay of four to six days. You will arrive the morning before the procedure and we will assess your current status and make the final preparations. We will use this opportunity to answer any questions you might have. On the day of the procedure, you will be taken from the ward to one of our two operating rooms, where the surgical team will meet you and perform the procedure.

Immediately after the procedure, you will be examined to make sure everything went well. We will then transfer you to a specialized monitoring ward where you will be cared for until the next day. On the following day, you will undergo a magnetic resonance examination to assess the surgical outcome and rule out any complications. Normally, you will then return to the standard ward and after another one or two days you will consult with a specialist and can then go home. During this last consultation, we will schedule appointments for further check ups.