Treatment:

Finding the best treatment for an AVM that is found on an x-ray or other imaging tests but is not causing any symptoms can be difficult. Your doctor will discuss with you:

• The risk that your AVM will break open (rupture). If this happens, there may be permanent brain damage.
• The risk of any brain damage if you have one of the surgical treatments listed below.

The long-term risk of bleeding is about 2 to 3% every year. Your doctor may discuss different factors that may increase the risk, including:

• Current or planned pregnancies
• Features of the AVM on an MRI or CT scan
• Size of the AVM
• Your age
• Your symptoms

A bleeding AVM is a medical emergency. The goal of treatment is to prevent further complications by controlling bleeding and seizures and, if possible, removing the AVM.

Three surgical treatments are available. Some treatments are used together.

Open brain surgery -- removes the abnormal connection through an opening made in the skull. It must be done by a highly skilled surgeon.

Embolization (endovascular treatment):

• A catheter is guided through a small cut in your groin to an artery and then to the small blood vessels in your brain where the aneurysm is located.
• A glue-like substance is injected into the abnormal vessels to stop blood flow in the AVM and reduce the risk of bleeding. This may be the first choice for some kinds of AVMs, or if surgery cannot be done.

Stereotactic radiosurgery is another alternative.

• This procedure delivers very focused radiation directly to the area of the AVM to cause scarring and shrinkinge.
• It is particularly useful for small AVMs deep in the brain, which are difficult to remove by surgery.

Anticonvulsant medications, such as phenytoin, are usually prescribed if seizures occur.

Expectations (prognosis):

About 10% of cases in which excess bleeding (hemorrhage) is the first symptom are deadly. Some patients may have permanent seizures and brain and nervous system (neurological) problems.

AVMs that do not cause symptoms by the time people reach their late 40s or early 50s are more likely to remain stable and rarely cause symptoms.

Complications:

• Brain damage
• Intracerebral hemorrhage
• Language difficulties
• Numbness of any part of the face or body
• Persistent headache
• Seizures
• Subarachnoid hemorrhage
• Vision changes
• Water on the brain (hydrocephalus)
• Weakness in part of the body

Possible complications of open brain surgery include:

• Brain swelling
• Hemorrhage
• Seizure
• Stroke

Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if you have:

• Numbness in parts of the body
• Seizures
• Severe headache
• Vomiting
• Weakness
• Other symptoms of a ruptured AVM

Also seek medical attention if you have a first-time seizure, because AVM may be the cause of seizures.