ARTERIOVENOUS MALFORMATIONS OF THE BRAIN

DEFINITION

Arteriovenous malformation or AVM is a congenital disorder of the connections between veins and arteries in the vascular system. The genetic transmission patterns of AVM (if any) are unknown, and AVM is not generally thought to be an inherited disorder--unless in the context of a specific hereditary syndrome. Arteries and veins are part of the human cardiovascular system. Normally, the arteries in the vascular system carry oxygen-rich blood at a relatively high pressure. Structurally, arteries divide and sub-divide repeatedly, eventually forming a sponge-like capillary bed. Blood moves through the capillaries, giving up oxygen and taking up waste products from the surrounding cells. Capillaries successively join together, one upon the other, to form the veins that carry blood away at a relatively low pressure. The heart acts to pump blood from the low pressure veins to the high pressure arteries. If the capillary bed is thought of as a sponge, then an AVM is the rough equivalent of jamming a tangle of flexible soda straws from artery to vein through that sponge. On arteriogram films AVM formation often resemble a tangle of spaghetti noodles. This tangle of blood vessels forms a relatively direct connection between high pressure arteries and low pressure veins. The result is a collection of blood vessels with abnormal connections and no capillaries. This collection, often called a nidus, can be extremely fragile and prone to bleeding.

AVMs may occur in isolation or as a part of another disease (e.g. Von Hippel-Lindau disease or hereditary hemorrhagic telangiectasia). This bleeding can be devastating, particularly in the brain. It can cause severe and often fatal strokes. If detected before a stroke occurs, usually the arteries feeding blood into the nidus can be closed off, ensuring the safety of the patient.

AVMs can occur in various parts of the body including the brain, spleen, lung, kidney, spinal column, and liver. Brain AVM's usually present with bleeding in the brain or seizures. Brain AVM's can be associated with brain aneurysms. Spinal cord AVM's can present with weakness or numbness of arms or legs. Evaluation is with CT, MRI, or angiography.

Treatment can be with surgery, stereotactic radiosurgery,  endovascular embolization, observation, or a combination of these treatments. Our group has specialty experience with all the modalities of brain and spinal cord avm treatment.