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As with most other brain lesions, the choice of treatment depends heavily on the location. If the AVM is accessible and in a relatively "non-eloquent" part of the brain, surgery is likely to be the best option. If the lesion is supplied by many blood vessels, some of which are difficult to reach and block surgically, your neurosurgeon may recommend endovascular embolization prior to an operation. Stereotactic radiosurgery can be employed in certain cases to treat AVMs that are too risky to remove by a direct operation.
Embolization employs the body's natural defenses to help it close off the malformation. By feeding particles or tiny coils into the AVM, doctors slow the flow of blood and encourage a clot to form which can shut down part of the blood flow within the malformation. By itself, embolization is rarely curative, but by reducing blood flow, it may make subsequent surgery easier and safer.
In stereotactic radiosurgery, a neurosurgeon uses a linear accelerator, proton beam, or gamma knife to generate beams of high-energy radiation which can be focused on the malformation while leaving nearby tissues unaffected. After the treatment, the affected blood vessels gradually wither and close down. This approach can only treat small AVMs (less than 3 centimeters) and also requires two to three years to reach its full effect, and for that reason is not the first choice of treatment after an AVM has bled. In eloquent areas of the brain where surgery could cause damage to vital functions, radiosurgery is often the only treatment option which can be used.
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