Arteriovenous Malformation (AVM) Specialists in New Jersey

A

n arteriovenous malformation (AVM) results from an abnormal entanglement of blood vessels that directs blood from a high-pressure artery to a low-pressure vein with too high a pressure gradient thereby risking potential blood vessel rupture. While AVMs can develop anywhere in the body, they most often occur in the spinal cord and the brain. This vascular abnormality can lead to a range of potential health complications. Therefore, finding the right specialist is crucial for proper diagnosis and treatment. Neurosurgeons treat AVM malformations in the brain or spine. When an AVM ruptures in the brain, it can cause a stroke. Any bleeding in the brain is called a cerebral bleed or a stroke.

Serving patients in northern New Jersey, the team of specialists at Centers for Neurosurgery, Spine & Orthopedics (CNSO) provides expert care for brain, spine, and nerve conditions, including AVMs. Discover more about this vascular anomaly and the care provided by the dedicated team of neurosurgeons at CNSO’s office locations across Bergen, Passaic, Essex, Morris, and Hudson counties.

What Is an Arteriovenous Malformation (AVM)?

Arteriovenous malformations disrupt the critical process of blood flow from a high-pressure arterial blood vessel gradually to a lower-pressure arteriolar capillaries vessel, then switching over to the lowest-pressure blood vessel which is the venous type system. AVMs cause a rapid flow of blood directly from arteries to veins, which also deprives nearby tissues of oxygen and nutrients. This derangement impacts surrounding tissues by bypassing the normal capillary network and placing the arterial venous system at risk of a rupture and hemorrhage requiring surgical intervention to save the patient’s life.

Normally, blood flows through the body within an organized, closed circuit of blood vessels, ensuring a constant supply. Arteries carry oxygen-rich blood from the heart to the brain and the body’s other organs and tissues. Veins return blood with less oxygen back to the heart and lungs.

The deprivation of oxygenated blood can lead to cell death and tissue damage. Furthermore, as the amount of blood flow increases, AVMs can grow, weakening over time and increasing the risk of bursting. If an AVM ruptures a hemorrhage is likely, necessitating immediate medical intervention, as bleeding in the brain can lead to a stroke or brain damage.

Causes and Risk Factors for AVMs

AVMs are extremely rare, affecting less than 1% of the population. The condition presents itself at about the same rate between men and women of all races and ethnicities. The exact cause of AVM remains unclear, but researchers believe genetic mutations and injuries to the central nervous system significantly contribute to the development of this vascular condition.

Typically, AVMs are congenital, meaning they exist at birth but are diagnosed later in life in many cases. Individuals with certain vascular conditions or abnormalities in blood vessels may be at a higher risk of developing AVMs.

While researchers have discovered specific risk factors that increase a person’s chances of an AVM, many cases occur with no identifiable contributing factors. Most abnormal entanglements of blood vessels are sporadic and develop without a clear cause or family history.

Signs and Symptoms of AVMs

Indicators of AVM can vary widely depending on the size and location of the malformation and whether it has ruptured. Symptoms can range in severity and may include:

• Headaches: Severe, sudden, or chronic headaches accompanied by nausea or vomiting can indicate an AVM. Frequency, duration, and intensity can vary greatly, with pain occurring on either side of the head or both.
• Seizures: New-onset or sudden seizures are common in patients with brain AVMs. Seizures can be focal or widespread and include convulsions, changes in consciousness, and loss of movement.
• Pain: Sudden back pain and pain in the lower extremities may be caused by an AVM in the spine.
• Muscle weakness and numbness: Patients with an AVM may experience muscle weakness or paralysis in one part of the body or face. This occurs because of degeneration of the nerve fibers within the spinal cord caused by the malformation.
• Vision problems: AVMs near the optic nerve or on the occipital lobe can create visual complications, such as blurred vision, visual field loss, or difficulty controlling eye movement.
• Trouble with speech: If the AVM is in the portion of the brain responsible for language processing, patients can develop a condition called aphasia, which affects the ability to speak, understand language, or both.
• Movement deficiencies: AVMs can cause difficulty with coordination and the ability to perform complex movements, particularly if the abnormality is in the brain or spinal cord.
• Ear noise: A buzzing or rushing sound can indicate an AVM, as the rapid flow of blood through the malformation creates a noticeable sound, which is referred to as a bruit.
• Cognitive or behavioral changes: Patients with an AVM may have trouble concentrating, confusion, memory problems, trouble carrying out tasks that require planning, changes in personality, hallucinations, or dementia.

Complications and Threats

Arteriovenous malformations in the brain can lead to several serious health complications and lower quality of life, particularly if the malformation bursts or grows over time. The health threats from an AVM include:

• Intracranial hemorrhage: Ruptures of an AVM can cause bleeding in the brain and lead to serious health problems, such as brain damage or death, making hemorrhage the biggest risk of AVMs.
• Stroke: By disrupting blood flow and limiting the supply of blood in certain areas of the brain, AVMs can create stroke-like events with symptoms such as weakness, speech difficulties, or paralysis.
• Neurological deficits: Over time, AVMs can cause progressive brain dysfunction, leading to worsening cognitive impairment, trouble remembering, and difficulty with motor skills, coordination, or speech.
• Hydrocephalus: The disruption of blood flow from an AVM can lead to the accumulation of cerebrospinal fluid within the brain, which can increase pressure and the risk of brain damage.
• Developmental delays: Due to the impact on normal brain function, AVMs can cause developmental delays, especially in children.

The severity and likelihood of complications associated with arteriovenous malformations largely depend on the condition of the malformation and how much it has progressed. Treatment and care from the board-certified neurosurgeons at CNSO can help mitigate these risks.

Diagnosing Arteriovenous Malformations at CNSO

CNSO aims to provide patients with accurate diagnoses and in-depth explanations of their conditions. When determining the presence of AVM, neurosurgeons perform thorough clinical evaluations that involve reviewing the patient’s medical history and symptoms. If the results of the neurological history and examination suggest an AVM, further diagnostic steps are recommended to confirm.

The primary diagnostic approach to confirm an AVM is advanced imaging techniques, such as:

• Cerebral angiography: This diagnostic technique involves injecting a contrast agent into an artery. The special dye highlights blood vessels in the brain on X-rays to provide neurosurgeons with an accurate visualization to confirm the presence of AVMs.
• Computer tomography (CT) scan: This advanced image test uses X-rays to create images of the head, brain, or spinal cord for AVM identification. It can be especially useful for revealing hemorrhage.
• Magnetic resonance imaging (MRI): The use of magnetic fields and radio waves to create detailed images is highly effective in detecting AVMs. The images provide an in-depth understanding of the brain’s structures and can show changes in neurological tissues associated with malformations.
• Magnetic resonance angiography (MRA): A type of MRI, this imaging test captures the pattern and the speed of blood flow throughout the brain and spinal cord to identify abnormal activity common with AVMs.
• Transcranial Doppler (TCD) ultrasound: This diagnostic technique involves using high-frequency sound waves to create an image of blood flow. It can help diagnose an AVM and detect the presence and extent of hemorrhage.

Options for Treatment of Arteriovenous Malformations

Treatment of AVMs depends on several factors, such as the size and location of the malformation, associated symptoms, the risk of rupturing, and the patient’s overall health. CNSO takes a conservative approach to treatment throughout the patient journey. The comprehensive care team at CNSO is expert at all stages, from diagnosis to follow-up to surgery and follow-up thereafter.

Treatment options available at CNSO aim to help patients manage their symptoms, prevent complications, and eliminate the AVM if necessary. If the AVM is small, does not produce symptoms, and is in a region of the brain that is difficult to access, monitoring the malformation may be the best approach. Periodic imaging is performed to determine whether the AVM is growing or causing complications. This is often the approach recommended by neurosurgeons when the AVM is deemed stable and not currently a threat, especially if the risks outweigh the potential benefits.

When treatment is not immediately needed but the AVM produces minor symptoms, medications may be prescribed to provide relief. This can include anti-seizure medications, pain relievers for headaches and back pain, and blood pressure medications. Regular imaging is conducted to track the size and growth of the AVM.

In cases where the AVM is accessible and patients can benefit from professional medical intervention, the highly skilled neurosurgeons at CNSO may suggest one of the following procedures:

Conventional Surgery

Surgery is typically a suitable treatment option when malformations are causing significant symptoms that impact the patient’s quality of life, are inaccessible regions of the brain, and when the risk of complications is manageable. During the surgical procedure, a neurosurgeon will enter the brain or spinal cord with precision and remove the AVM, being careful not to damage surrounding neurological structures. This treatment option is not typically performed for AVMs located deep within the brain due to the risk of damaging or destroying important brain tissue.

Endovascular Embolization

This minimally invasive treatment involves threading a catheter through an artery until it reaches the site of the AVM. From there, the surgeon will inject a glue-like substance or coils into the AVM to create an artificial blood clot and block the abnormal blood vessels, reducing blood flow to the malformation.

Embolization usually does not remove the AVM and is mostly performed as a pre-surgical treatment to shrink the AVM, making it easier and safer to remove. It can be used as a standalone treatment if surgical intervention is too risky.

Radiosurgery

This treatment approach uses highly focused beams of radiation to target the AVM, damaging the walls of the blood vessels and causing the malformation to shrink and eventually close over time. Radiosurgery is a non-invasive procedure often recommended for treating small arteriovenous malformations that do not cause acute symptoms and have not ruptured.

Frequently Asked Questions About Arteriovenous Malformation (AVM)

What is an arteriovenous malformation (AVM)?

An AVM is an abnormality impacting the connection between arteries and veins, bypassing the normal capillary system. AVMs cause irregular blood flow, which can lead to several symptoms and potentially dangerous complications.

What causes an AVM?

Scientists have yet to discover the exact cause of AVMs. While the abnormality is not fully understood, experts have concluded that the condition is often congenital, meaning it is present at birth.

What are the symptoms of an AVM?

The symptoms associated with arteriovenous malformation can vary depending on the size of the AVM and where it is located. Common symptoms include:

• Severe, sudden headaches
• Seizures
• Weakness or numbness in parts of the body, particularly the lower back and lower limbs
• Trouble speaking or understanding speech
• Vision impairment
• Ringing in the ears
• Loss of consciousness
• Confusion

What happens if an AVM bursts?

A ruptured AVM can lead to a hemorrhagic stroke caused by bleeding in the brain. In this circumstance, patients often experience neurological deficits and require immediate medical attention.

Is surgery always the treatment for an AVM?

While surgery is an effective approach for removing an AVM, it is not always the recommended treatment. Less invasive treatment options, such as embolization and radiosurgery, may be recommended instead. Surgery is usually only considered for AVMs that cause severe symptoms and are in accessible locations. The risk of surgical intervention is also considered when discussing treatment options.

Turn to the Board-Certified Team at Centers for Neurosurgery, Spine & Orthopedics

When it comes to arteriovenous malformations, trust the dedicated surgical and non-surgical team at Centers for Neurosurgery, Spine &Orthopedics. Patients receive coordinated and comprehensive care.

CNSO’s leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists are committed to providing top-quality care in a welcoming setting. CNSO offers multiple convenient locations across northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. To learn more about effectively treating AVMs, contact the doctors at CNSO today.