Minimally Invasive Procedures

Arteriovenous malformation embolization

AVM’s are congenital lesions of the brain, meaning that they develop prior to birth. AVM’s are very complex lesions and the treatment of this disease is equally as complex.

Because an AVM has shunted blood flow away from normal brain next to itself for all of a person’s life, abruptly closing some AVMs by treating them all at once may cause problems. If the AVM is large, or if the blood flow through the AVM is great, the surrounding brain will need time to get used to a normalization of blood flow. If not, normal surrounding brain may become “leaky” and bleeding may occur. This is called a perfusion pressure breakthrough hemorrhage. These hemorrhages can be avoiding by blocking the AVM blood supply in stages. This may require multiple operations, each one building on the preceding operation to progressively obliterate the AVM and normalize blood flow to the surrounding brain.

The procedure itself involves navigating a tiny tube, called a catheter, from a groin artery to the brain AVM. Once there special glue and or coils or particles are injected into the AVM, blocking it off. In a small, low flow AVM the procedure may be performed once only. For larger AVM’s the procedure will be repeated days, weeks or months later, as described above.

The procedure is usually performed under general anesthesia. Occasionally, patients will be kept anesthetized for a day or so after the procedure. This allows normal surrounding brain to become accustomed to the normalization of blood flow and reduces the risk of post-operative brain bleeding. This may be done for large, high flow AVM’s where embolization has resulted in significant size or flow reductions.

If embolization is unable to completely block the AVM patients will then undergo conventional surgery for removal or stereotactic radiosurgery.