AVM (Arteriovenous Malformation)
At the Henry Ford Cerebrovascular Center, our physicians have been among the leading AVM (arteriovenous malformation) experts in the region for 40 years, drawing patients from Michigan, the Midwest and around the U.S. as well as internationally.
AVM expertise at Henry Ford
Our surgeons treat AVMs ranging from basic to extremely complex with microsurgical and endovascular treatments. In fact, their level of expertise means that even the most challenging cases are routine procedures here.
- High volume equals unmatched expertise: While AVMs affect less than 0.5 percent of the population, Henry Ford’s physicians have treated more than 1,400 cases. Of only 64 cases reported in the medical literature of patients with a cavernous malformation affecting the optic pathways, four of those patients have sought treatment at Henry Ford.
- Knowledge as power: The Cerebrovascular team remains in contact with many former patients and provides follow-up care as needed. As a result, our physicians have access to a powerful database of information about treating AVM. It also allows for monitoring of treatment outcomes.
What is AVM (arteriovenous malformation)?
Arteriovenous malformation (AVM) is a tangle of blood vessels, most commonly in the brain. Instead of being connected by tiny capillaries, like normal vessels, these arteries and veins connect directly. The AVM can cause headache, seizure and other symptoms. If the AVM ruptures, it can cause bleeding in the brain (hemorrhage). This bleeding can result in stroke or brain damage as well as risk to life.
Signs and symptoms of AVM
Many AVMs do not cause any signs or symptoms unless the AVM ruptures. In about half of brain AVMs, a hemorrhage (bleeding in the brain) is the first sign of the AVM.
A ruptured AVM can cause a hemorrhagic stroke. Its symptoms include:
- Confusion and difficulty speaking
- Weakness or numbness in the face or body
- Difficulty walking
- Sudden headache
People who do experience symptoms from an unruptured brain AVM may experience:
- Headache or pain in one area of the head (sometimes severe)
- Numbness, muscle weakness or paralysis in one part of the body
- Vision problems
- Difficulty speaking or understanding others
- Severe unsteadiness
Most people who experience symptoms of a non-ruptured AVM notice them between the ages of 10 and 40. Symptoms may worsen during pregnancy, as blood volume and blood pressure change. This risk of bleeding , however, continues throughout one’s lifetime.
Complications of AVM
The most commonly known complication of an AVM is bleeding in the brain or hemorrhage. This risk is about 2-3 percent per year for any given patient with an arteriovenous malformation. Brain AVMs cause about 2 percent of hemorrhagic strokes each year, and are the most likely cause of brain hemorrhage in young adults and children.
Other complications of AVM may include:
- Weakened blood vessels. When an AVM pressures blood vessel walls, a bulge (aneurysm) may develop in a weak vessel. This bulge has a risk of rupture.
- Reduced oxygen to brain tissue. Blood rushes quickly through an AVM, without giving brain tissues time to absorb sufficient oxygen from the blood. Complications may include weakness, numbness, vision loss, severe unsteadiness or other stroke-like symptoms.
- Brain damage. As an AVM grows, it may compress or displace parts of the brain or prevent fluids in the brain from protecting brain tissue.
Fortunately, timely treatment by the experienced physicians at Henry Ford can minimize the complications of AVM.
What causes AVM?
The cause of AVMs is unclear. Many people are born with them. Occasionally, AVMs form in adulthood. Some researchers believe brain AVMs develop during the fetal stage.
AVMs affect less than 0.5 percent of the population. The likelihood of AVMs does not appear to be greater among family members of people who have an AVM unless more than one immediate family members are affected..
Expert diagnosis of AVM at Henry Ford
Physicians at Henry Ford detect most AVMs using brain imaging or scans. Doctors also use these tests to collect information about the size of the AVM, its location and whether it has ruptured or bled (hemorrhaged).
To diagnose brain AVMs, our team uses tests including:
- Cerebral arteriography or cerebral angiography to reveal the location and type of arteries and veins that feed into an AVM, so that physicians can make an accurate plan to treat the AVM.
- Computerized tomography (CT) scan, which creates a detailed cross-sectional image of a person’s brain via a series of X-rays. Physicians sometimes use injected dye to view the AVM’s arteries and veins in greater detail (called a computerized tomography angiogram).
- Magnetic resonance imaging (MRI), to create detailed images using powerful magnets and radio waves. An MRI can provide the precise location of the malformation. MRI also can reveal whether the AVM has ruptured or bled. If the doctor injects dye to view how the blood circulates in the brain, the test is called a magnetic resonance angiogram.
AVM treatment at Henry Ford’s Cerebrovascular Center
Henry Ford’s experts are leaders in treating AVM in Michigan and the U.S. Our physicians at the Cerebrovascular Center are highly skilled at selecting the right AVM treatment to prevent or repair hemorrhage, control seizures or reduce other neurological complications. At a regular multidisciplinary conference, physicians meet to discuss the treatment plan of each AVM.
Thanks to our collaborative and multidisciplinary approach, patients receive thorough evaluation and treatment from neurosurgeons, endovascular specialists and neurologists working closely together.
Treatment may include:
- Surgery (also known as resection). Surgical removal of an AVM might be possible if the malformation is in an area that can be accessed easily for surgery. We may also recommend surgery if the AVM has bled. The surgeon removes a portion of the skull temporarily. Then, using a high-powered microscope, the surgeon uses clips or coagulation techniques to seal off the AVM, and then carefully removes the malformation from the surrounding brain tissue. Henry Ford also has capabilities for intraoperative angiography, videography and MRI, which help to make procedures more precise.
- Stereotactic radiosurgery. A smaller AVM that open surgery cannot reach may be treated with stereotactic radiosurgery. The procedure uses high-energy radiation beams to damage the vessels that feed the AVM. Over time, the vessels will close off, starving the AVM of its blood supply and causing it to shrink.
- Endovascular surgical preparation and embolization. Endovascular neurosurgery, or surgery within the vessels, places material inside the vessels to block them, starving the vessels of blood and causing them to shrink. The treatment may use micro coils, small particles or glues (liquid tissue adhesives). The surgeon inserts a long, thin tube into a leg artery and uses X-ray imaging to guide the tube through blood vessels into the brain. This treatment sometimes is used before surgery, to reduce the risk of bleeding.
- Medications also may be used to treat an AVM’s symptoms, such as headaches or seizures, though the medications do not prevent bleeding.
Read more about our Cerebrovascular Center.