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There are many ways you can help children and their families get the care they need.
The choice of treatment for brain arteriovenous malformations (AVMs) is very individual and will depend on the AVM’s complexity, how easy it is to reach surgically and whether removing it would run the risk of interfering with vital brain functions.
In addition to treating the brain AVM itself, Boston Children’s Hospital addresses any neurological symptoms it may have caused, referring patients to physical therapists, occupational therapists or speech and language therapists as needed and providing close support to help children and families cope with any resulting disability.
At Boston Children’s Hospital, the usual approach to AVMs is to attempt surgical removal if feasible and safe.
If your child is having surgery for an AVM, plan to spend about four hours in the pre-operative clinic to meet with nurses, the anesthesiologist and the neurointerventionalist. You will receive instructions ahead of time on how to prepare.
Endovascular embolization is a minimally invasive, catheter-based technique that seeks to close off as much blood flow as possible to the AVM. By itself, embolization is rarely curative for AVM, but it can make surgery easier and safer, decreasing blood loss and providing a clean field for the surgeon’s operation.
Embolization is performed under general anesthesia by a neurointerventionalist with the help of specialized anesthesiologists, nurses and technologists and x-ray guidance. Parents will receive instructions on how to prepare ahead of time.
When traditional surgery is too risky because the brain AVM is hard to reach or is in an “eloquent” area of the brain (with vital functions such as language), our team may recommend radiosurgery. Most often used to treat hard-to-reach brain tumors, stereotactic radiosurgery involves no incisions. Instead, the radiosurgeon aims a beam of high-energy radiation at the AVM.
If your child is scheduled to come to Boston Children’s, you will receive specific information on how to prepare. Because these procedures involve general anesthesia, we usually ask patients to refrain from eating, drinking and sometimes from taking medicines for a certain period of time.
After treatment, most children leave the hospital within a few days. Sometimes, if the situation warrants, we will admit the child to the ICU for several days of observation. Children then return for a follow-up office visit within a few weeks of discharge.
We also perform a follow-up angiogram one year after surgery to verify that there is no residual or recurrent AVM. If this angiogram is “clean,” we then follow patients with MRI scans, at first annually, and then less frequently. Follow up may be in part through video teleconference for patients who live outside the Boston area.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”