An intracranial arteriovenous malformation (AVM) is a snarl of arteries and veins in the brain that create abnormal connections between one another and interrupt the flow of blood. One of the biggest risks of this vascular disorder is the chance of rupture, which could cause intracranial hemorrhage. Bleeding inside the brain can be extremely dangerous because it can create a buildup of pressure that may damage brain cells, while the interruption to the blood supply can cause other cells to die because they do not receive sufficient oxygen and nutrients. At the time of diagnosis, a doctor can discuss how to proceed in the management of an intracranial arteriovenous malformation.
The reasons behind the formation of intracranial arteriovenous malformations are not well understood. The groundwork is thought to be laid during fetal development, when the pathways for brain development are created, and as a child grows older, the growth gets larger. Some people never experience symptoms, while others start to develop headaches and other neurological problems. In some cases, the first warning sign is a stroke when the malformation ruptures.
A doctor may suspect an intracranial arteriovenous malformation as a possibility if a patient has neurological symptoms consistent with some kind of problem in the brain. A medical imaging study can reveal the growth and provide information about its precise location and nature. This can be important for planning treatment, as there could be several treatment options available. The doctor can discuss the formation with the patient and discuss the choices.
One way to treat an intracranial arteriovenous malformation is surgery. A surgeon can access the involved area of the brain and address the abnormal growth. Vascular embolization may also be an option. In this procedure, the surgeon carefully advances catheters through the blood vessels to the area of the malformation and blocks off blood vessels to limit the supply of blood. This kills off the growth and allows the brain to reroute other vessels around it.
If an intracranial arteriovenous malformation ruptures, the patient needs emergency treatment. This can include surgery to open up the skull and relieve pressure. In some cases, the surgeon may also be able to access and tie off blood vessels to stop the bleed. Once the patient is out of surgery, some hospitalization may be necessary to allow care providers to monitor cognitive function during healing. Some patients need temporary shunts or ports to relieve pressure and allow fluid to drain from the brain while they heal.