From the Guidelines
The treatment of arteriovenous malformations (AVMs) should be individualized based on patient factors, including age, overall health, and symptoms, with the goal of preventing hemorrhage and improving quality of life, as supported by the American Stroke Association's recommendations 1. The treatment options for AVMs include:
- Surgical resection to completely remove the AVM
- Endovascular embolization to block blood flow through the abnormal vessels using materials like glue or coils
- Stereotactic radiosurgery (such as Gamma Knife) to gradually destroy the AVM over 1-3 years
- Conservative management with observation for low-risk AVMs For patients with seizures due to AVMs, anticonvulsant medications like levetiracetam (500-1500 mg twice daily) or carbamazepine (200-400 mg twice daily) may be prescribed, as mentioned in the guidelines 1. The goal of treatment is to prevent hemorrhage, which is the most serious complication of AVMs, as they have a 2-4% annual bleeding risk that can cause significant neurological damage or death, as highlighted in the studies 1. Complete obliteration of the AVM is considered curative, eliminating the risk of future bleeding, and can be achieved through radiosurgery, which has been found to be a safe and effective treatment for specific AVMs, with approximately 80% of patients achieving complete AVM obliteration within 2 to 3 years, as reported in the literature 1. Some key considerations in treatment decisions include:
- AVM size and location
- Patient age and overall health
- Risk of bleeding and other symptoms
- Potential benefits and risks of each treatment option As stated in the guidelines, the treatment of AVMs requires a multidisciplinary approach, and the choice of treatment should be based on a thorough evaluation of the patient's individual circumstances, as recommended by the American Stroke Association 1.
From the Research
Treatment Options for Arteriovenous Malformation (AVM)
The treatment of AVMs can vary depending on the characteristics of the patient and the specific characteristics of the AVMs. Some of the treatment options include:
- Microsurgical resection 2, 3
- Radiosurgical ablation 2, 4, 5
- Endovascular embolization 2, 4, 5, 6
- Combination of these treatment options 2, 4, 5
- Conservative management or observation 4, 6
Factors Influencing Treatment Decisions
The decision to treat an AVM and the choice of treatment depend on various factors, including:
- Characteristics of the patient 2, 4, 3
- Characteristics of the AVM, such as location, size, and complexity 2, 4, 3
- Risk of neurologic injury in functional areas of the brain 4
- Natural history of hemorrhage 4
Goals of Treatment
The primary goal of AVM treatment is to: