AVM Resection

Arteriovenous Malformations (AVMs) are abnormal tangles of blood vessels that disrupt normal blood flow between arteries and veins in the brain or spinal cord. These malformations pose a significant risk of hemorrhagic stroke due to vessel rupture, leading to severe neurological complications. AVM resection is a surgical procedure that aims to completely remove the AVM, eliminating the risk of future bleeding and associated health concerns.

What is AVM Resection?

AVM resection is a microsurgical procedure performed by a vascular neurosurgeon to completely remove an arteriovenous malformation. The surgery involves:

1. Performing a craniotomy (for brain AVMs) or spinal exposure (for spinal AVMs) to access the lesion.

2. Carefully separating the AVM from surrounding brain or spinal tissue while preserving normal blood vessels.

3. Clipping or sealing feeding arteries and draining veins to prevent abnormal blood flow.

4. Excising the AVM completely to eliminate the risk of rupture.

By removing the AVM entirely, this procedure restores normal blood circulation and significantly reduces the chances of future neurological complications.

Benefits of AVM Resection

• Permanent Treatment: Complete removal eliminates the risk of AVM rupture.

• Prevents Stroke: Reduces the chances of hemorrhagic stroke and related disabilities.

• Restores Normal Blood Flow: Improves brain or spinal cord function by removing abnormal vessel connections.

• Immediate Risk Reduction: Unlike other treatments that take time to work, surgery provides an instant cure in eligible cases.

While other treatment options, such as embolisation and stereotactic radiosurgery, may be considered for some cases, resection remains the gold standard for complete AVM removal.

When is AVM Resection Recommended?

Surgical resection is recommended when:

• The AVM is small to medium-sized and located in an accessible brain or spinal region.

• The AVM has previously caused a hemorrhage (bleeding in the brain or spinal cord).

• The patient has experienced seizures, neurological deficits, or chronic headaches due to the AVM.

• The AVM is at high risk of rupture, even if asymptomatic.

• Non-surgical treatments (such as embolisation or radiosurgery) are not suitable or have failed to control the AVM.

AVM resection is typically not recommended for deep-seated or highly complex AVMs, where alternative therapies may be safer.

Diagnosis and Treatment Process

Diagnosis: To determine the best treatment approach, a thorough evaluation is conducted using:

• Neurological Examination: To assess symptoms such as weakness, headaches, or seizures.

• Imaging Studies:

  • Magnetic Resonance Imaging (MRI): Provides detailed images of the AVM’s location.

  • Computed Tomography (CT) Scan: Helps detect past hemorrhages or associated brain swelling.

  • Cerebral Angiography (Digital Subtraction Angiography - DSA): The gold standard for mapping AVM blood flow and structure.

Treatment Process:

• Pre-Surgical Planning: Imaging and angiographic studies are used to plan the safest surgical approach.

• Anesthesia and Craniotomy (or Spinal Exposure): The patient is placed under general anesthesia, and the surgical site is carefully exposed.

• AVM Removal: The neurosurgeon isolates and excises the AVM while preserving normal blood vessels.

• Hemostasis and Closure: The surgical site is checked for bleeding, and the bone flap (if a craniotomy was performed) is repositioned.

• Post-Surgical Monitoring: Patients are closely monitored in the intensive care unit (ICU) before transitioning to recovery and rehabilitation.

Recovery and Follow-Up

• Hospital Stay: Most patients stay a few days to a week for post-operative monitoring.

• Neurological Rehabilitation: Physical or occupational therapy may be required if deficits were present before surgery.

• Follow-Up Imaging: An angiogram, MRI, or CT scan ensures complete AVM removal and assesses brain recovery.

Conclusion

AVM resection is a highly effective and permanent treatment for vascular malformations in the brain and spine, significantly reducing the risk of life-threatening hemorrhages and neurological complications. While non-surgical options may be suitable for some patients, complete surgical removal is the most recommended option for accessible AVMs with a high rupture risk. Schedule a consultation with us today to learn more.