Brain Arteriovenous Malformations (AVMs) | Diagnosis and Treatment

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How are brain arteriovenous malformations diagnosed?

The first step in diagnosing brain arteriovenous malformations (AVMs) is often neurological testing to assess the child’s brain function. Genetic testing may also be recommended if your clinician suspects an inherited disorder.

To help choose the best treatment, your clinician may also order one or more of the following imaging tests:

How are brain arteriovenous malformations treated?

The choice of treatment for brain arteriovenous malformations (AVMs) is very individual and depends on the AVM’s complexity, how easy it is to reach surgically and whether removing it would risk interfering with vital brain functions.

In most cases, AVMs are removed by surgery if this option is safe and possible.

Endovascular embolization

If the AVM is complex, especially if it is supplied by deep, hard-to-reach blood vessels, the clinician may recommend endovascular embolization as a separate step before surgery.

Endovascular embolization is a minimally-invasive technique that closes off as much blood flow as possible to the AVM. It can make surgery easier and safer. Embolization is performed under general anesthesia by a neurointerventionalist with the help of specialized anesthesiologists, nurses and technologists, using x-ray guidance.

During the procedure, the neurointerventionalist inserts a catheter (a thin, flexible tube) into an artery in the groin through a tiny incision and guides it to the AVM. The catheter injects a specially-designed medical glue, filling as much of the area around the AVM as possible. In most cases, the child will have embolization first, stay overnight in the ICU, and then have surgery the following morning.

Stereotactic radiosurgery

Stereotactic radiosurgery is often used when traditional surgery is too risky because the brain AVM is hard to reach or is in an area of the brain that controls vital functions such as language. This procedure involves no incisions. Instead, the radiosurgeon aims a tightly focused beam of high-energy radiation directly at the AVM. This radiation causes the abnormal blood vessels to wither and close down after treatment.

Other types of treatment

In addition to surgery, some children may also need treatment for any neurological symptoms the AVM may have caused. Treatments can include physical therapy or occupational therapy or speech and language therapy.

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