Arteriovenous Malformation (AVM) Surgery in New Jersey

An arteriovenous malformation, or AVM, refers to a maladaptive formation of tangled blood vessels that disrupts normal blood flow and poses a risk of bleeding that can cause serious injury and death. AVMs can form anywhere in the body but are most common and dangerous when they occur in the spinal cord and brain. Neurosurgical intervention is often necessary to prevent complications such as seizures and cerebral hemorrhage that can cause increased intracranial pressure, neurological injury, and death. Finding the right neurosurgeon is crucial to ensure proper treatment with minimal risk.

Centers for Neurosurgery, Spine & Orthopedics (CNSO) provides specialized care for AVMs and other brain, spine, and nerve conditions at locations throughout New Jersey. Learn more about AVM surgery and treatment options available from the expert team of specialists at CNSO.

What Is an Arteriovenous Malformation?

The circulatory system is a complex yet organized network of blood vessels that transports blood throughout the body. Arteries carry oxygen-rich blood from the lungs to all other parts of the body, while veins return blood to the lungs via the heart. This closed circuit ensures the brain, muscles, organs, and other tissues receive a constant supply of oxygen and vital nutrients. Arteriovenous malformations (AVMs) are connections between the arterial side and the venous side of the circulatory system, that lack supportive structures.

Normally blood flows out of the heart into the arteries, then through smaller and smaller arteries, into capillaries where the blood supplies oxygen and nutrients to the tissues. Blood then collects and flows into the venous system through small veins that connect to larger veins and returns the blood to the heart. As the blood flows from the high-pressure arterial system, the pressure decreases as it flows through the small capillaries and then flows into the low-pressure venous system. AVMs are a group of arterial blood vessels, with many branches, that each form abnormal connections directly into the venous blood vessels. Rather than blood flowing through capillaries between the two systems, blood rushes directly from the high-pressure arterial side into the low-pressure venous side.

The irregular blood flow subjects the blood vessels within the AVM to higher pressures than they can continuously withstand. The venous side of the AVM weakens over time and can eventually rupture which causes significant bleeding in the brain. A cerebral hemorrhage is a stroke. Significant hemorrhaging from blood vessels in the brain requires a brain surgeon to stop the bleeding and evacuate the blood to prevent permanent disability and/or death. Ideally, an AVM should be prophylactically treated by a brain surgeon, a.k.a. neurosurgeon, before it ruptures. Preemptively treating an AVM prevents a stroke from occurring.

AVM Signs and Symptoms

Most patients experience no initial symptoms at all and learn of their brain AVM by incidental findings. Others do experience mild symptoms of an AVM which vary depending on its location within the brain and its size. More severe symptoms and noticeable signs appear only after a rupture. These signs and symptoms are due to hemorrhage or blood clots placing pressure on the surrounding brain tissue. These symptoms vary in severity and intensity may include:

• Headaches: Sudden, severe, or chronic headaches can indicate an AVM. Pain may occur on either or both sides of the head and can vary in duration and intensity.
• Nausea: Sudden, unexplained nausea or vomiting may be a sign of an AVM, especially when accompanied by a headache or other symptoms.
• Backache: Spinal AVMs can compress or displace sections of the spinal cord, causing sudden back pain or pain in the lower limbs and extremities.
• Muscle weakness: AVMs may cause weakness, numbness, or paralysis in a localized area of the body. This is caused by nerve compression or degeneration.
• Seizures: Sudden onset seizures are common symptoms of brain AVMs. Seizure signs include convulsions, loss of control over movement, or changes in consciousness.
• Vision problems: If an AVM is near the optic nerve or on the occipital lobe, it may create visual difficulties such as blurriness, field loss, or changes in eye movement.
• Ear noise: Some patients with AVMs may experience a buzzing or rushing sound, called a bruit, caused by rapid blood flow through the malformation.
• Sensory changes: Patients with an AVM also may experience other sensory differences, such as numbness, tingling, or spontaneous pain in localized parts of the body.
• Speech troubles: If the AVM affects the part of the brain that processes speech, patients can develop aphasia. This condition impacts the ability to speak or understand language.
• Lost mobility: In addition to sensory changes, AVMs also may cause difficulty with coordination. This makes it difficult for patients to perform complex or precise movements.
• Brain fog: Patients with an AVM may experience confusion or memory problems, have difficulty concentrating, or struggle to complete tasks that require complex planning.
• Personality changes: Patients with AVMs may display subtle behavioral or developmental differences. If the AMV ruptures, it can cause dramatic personality changes.

Not every patient will experience all these symptoms. In addition, many of these symptoms may be caused by other health problems. It is important that patients take their concerns to a healthcare provider for testing and a proper diagnosis.

AVM Causes and Risk Factors

AVMs are extremely rare. They affect men just as frequently as women and are equally common in all races and ethnicities. While AVMs can form anywhere in the body, they are most common in the brain and around the spinal cord.

Most AVMs are congenital, meaning they form during fetal development. They can sometimes appear after birth or later in life. The exact reason AVMs occur is not clear. They may be inherited due to a genetic defect, though it is more likely that other inherited conditions simply increase the risk of developing an AVM. They also may be caused by issues during development in the womb. When AVMs form later in life, they may be the result of injury to the nervous system.

How Are AVMs Diagnosed?

Most AVMs are identified incidentally while the patient undergoes an evaluation for an unrelated disorder. In other cases, an AVM can cause seizures, stroke-like symptoms, or rupture producing symptoms that bring the issue to medical attention.

CNSO is committed to providing patients with accurate diagnoses to inform correct care. If a patient has been referred to CNSO with symptoms that may be related to an AVM, neurosurgeons will perform thorough clinical evaluations of the patient’s medical history and symptoms. Advanced imaging techniques may then be used to confirm a diagnosis suggested by the exam, such as:

• Cerebral angiography: The neurosurgeon injects a special dye, called a contrast agent, into the patient’s artery. The agent highlights blood vessels when taking an X-ray, providing a detailed visualization that makes AVMs easier to identify.
• Computer tomography (CT) scan: This imaging technology uses X-rays to create images of internal structures, including the brain, skull, and spinal cord. It is especially useful for revealing abnormal bodies and hemorrhages.
• Magnetic resonance imaging (MRI): When detecting AVMs, the use of magnetic fields is highly effective. The fields provide highly detailed and accurate images of soft tissues that can be used to understand the brain’s structures and identify changes associated with a malformation.
• Magnetic resonance angiography (MRA): This technique is a type of MRI used to evaluate the speed and pattern of blood flow in the brain and spinal cord. Abnormal or irregular flow may indicate an AVM.
• Transcranial Doppler (TCD) ultrasound: Like an MRA, this imaging test is used to evaluate blood flow. Instead of using magnetic fields, however, it uses high-frequency sound waves to measure the speed at which blood moves through the brain.

Non-Surgical AVM Treatment Options

Effective treatment for AVMs depends on a variety of factors. The size of the malformation, its location, and its risk of rupturing all influence the proposed care plan. The patient’s overall health and any symptoms caused by the AVM are also considered.

At CNSO, a conservative approach to pain management and treatment is always prioritized. With every patient’s case, doctors consider whether a proven, evidence-based, non-invasive treatment will be successful in addressing the patient’s symptoms. Non-invasive treatments will not make the AVM go away. However, they may help manage symptoms and reduce the risk of a rupture, especially if the AVM is deemed not to be an active threat.

Monitoring is a frequent strategy to treat an AVM, especially if the AVM does not produce symptoms or if immediate treatment is deemed too risky. Neurological surgeons perform regular imaging exams to watch the AVM and ensure it does not grow or cause new complications. If the AVM causes minor symptoms, medications may be prescribed for relief. These may include anti-seizure medications, blood pressure medications, and pain relievers to address head or back pain.

AVM Brain Surgery at CNSO

If the AVM causes severe symptoms, is at high risk of hemorrhage, and is accessible via surgery, CNSO neurosurgeons may recommend professional medical intervention. The comprehensive care team at CNSO works together to deliver the best care at all stages of treatment, from diagnosis to surgery if necessary. They are expert in performing the following treatments for AVM:

Conventional Surgery

Conventional surgery is typically suggested for patients whose malformations are in accessible regions of the brain and present minimal risk of complications. This procedure involves making a small cut near the AVM, which the surgeon uses to access the brain or spinal cord. The neurosurgeon seals surrounding veins and arteries to eliminate bleeding, then removes the AVM. Blood flow is then redirected to normal blood vessels. Patients typically stay in the hospital for a few days and if necessary, short-term rehabilitation. A brain scan also may be performed to ensure the AVM has been fully removed.

Embolization

Endovascular embolization is the preferred technique to treat large AVMs with significant blood flow. It involves inserting a catheter into an artery in the groin or wrist. The catheter is then carefully threaded toward the site of the AVM, where it is used to inject coils or a glue-like substance into the AVM. This creates a blood clot that slows or halts flow through the abnormal blood vessels. Embolization is typically performed as a pre-surgical treatment, allowing neurological surgeons to remove the AVM with less risk of bleeding. It also may be used as a standalone treatment when surgery is deemed too risky.

Radiosurgery

If the AVM is very small and has not yet ruptured, a minimally invasive treatment may be effective in eliminating the malformation. The radiosurgery approach uses a highly focused beam of radiation aimed directly at the AVM. The beam damages the walls of the blood vessels making up the malformation, causing it to shrink. It will gradually degenerate and close during the first several months following treatment. This destroys the AVM and restores normal blood flow without requiring surgical intrusion. CNSO neurosurgeons will monitor the AVM to ensure it does not rupture during the degeneration process.

Follow-Up and Recovery

After receiving surgical treatment for an AVM, patients will need regular follow-up visits. These visits allow the medical team to monitor for recurrence of the AVM and to provide follow-up treatment if necessary.

The expected recovery period depends on the treatment used. Patients who receive embolization and conventional surgery typically have a short hospital stay with minor rehabilitation. Patients who receive radiotherapy may go home the same day as their procedure, but the AVM will not fully close for several months or up to two years. It will require constant monitoring to confirm that it does not rupture during this time and that further treatment will not be required.

Receive Treatment for AVMs at CNSO

Arteriovenous malformations (AVMs) can lead to dangerous health consequences if not addressed by a specialist. The committed and compassionate team at Centers for Neurosurgery, Spine & Orthopedics (CNSO) delivers comprehensive care to help patients find the treatment they need without complications.

Surgical and non-surgical solutions are delivered by leading board-certified neurosurgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists. CNSO offers multiple convenient locations across New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. To learn more about AVM treatments, contact the doctors at CNSO today.

Frequently Asked Questions About Arteriovenous Malformations (AVMs)

What is an arteriovenous malformation (AVM)?

An arteriovenous malformation, also called an AVM, is an abnormal connection between arteries and veins that allows blood to bypass its regular route. It causes irregular blood flow, which may lead to dangerous complications.

What causes an AVM?

Scientists are still unsure what causes AVMs. They have confirmed the condition is usually congenital, meaning it is present at birth, and may have a hereditary link.

What are the symptoms of an AVM?

Symptoms of an AVM depend on its location, size, and whether it has burst. The most common symptoms include:

• Severe, sudden headaches
• Seizures
• Weakness in parts of the body
• Trouble speaking or understanding speech
• Numbness or a tingling sensation
• Vision impairment
• Ringing in the ears
• Loss of consciousness
• Confusion

What happens if an AVM ruptures?

AVMs can weaken over time. If they rupture or burst, they create bleeding in the brain leading to a hemorrhagic stroke. When this happens, patients often experience neurological symptoms and need immediate medical intervention.

Is surgery always the treatment for an AVM?

Though open surgery provides the best chance of completely removing and curing an AVM, surgery is not always the recommended treatment for an AVM. Monitoring and medication may be used to manage symptoms if the AVM does not present a threat. Minimally invasive surgical options such as embolization and radiosurgery are also available typically for smaller AVMs. Conventional surgery is recommended when an AVM is in an accessible location or if the AVM is too big for radiosurgery or to be completely embolized.