Multidisciplinary Care for Aneurysms and Arteriovenous Malformations (AVMs)

The brain is an organ of exquisite complexity, and its health is paramount to our overall well-being. Among the myriad of conditions that can affect the brain, arteriovenous malformations (AVMs) pose a significant threat due to their potential to cause serious complications. 

Here, we explore this precarious condition and discuss what individuals need to know about severity, prevalence, life expectancy, survival rates, and treatment options. We particularly emphasize the indispensable role of multidisciplinary care provided by neurovascular centers in diagnosing and addressing AVMs.

How Serious Is a Brain AVM?

Brain AVMs are an abnormal cluster of blood vessels that arise between arteries and veins, bypassing the capillary system. The cluster of AVM vessels is often described as a “nest” of twisted vessels that contains high-flow, high-pressure blood. The abnormal AVM vessels are often silent, without causing any symptoms, however they can suddenly rupture and cause life-threating bleeding in the brain.  A brain AVM is a serious conditions due to the potential to cause bleeding in the brain, seizures, or other neurological problems such as headaches or stroke. 

The risk of hemorrhage in untreated brain AVMs is 2-4% per year, and each hemorrhage carries a 10-15% risk of death and 40% risk of significant neurological impairment. The yearly risk of brain AVM bleeding is considered to be low, however the lifetime risk of bleeding is cumulative over a patient’s lifetime. This underscores the importance of timely diagnosis and management to mitigate these risks.

Where is the Most Common Location of AVMs in the Brain?

AVMs can occur anywhere within the brain or on its covering. However, they are most commonly found in the cerebrum, the largest part of the brain that is involved in voluntary activities, sensory processing, vision, speech and thought. The specific impacts of an AVM, including symptoms and treatment options, can vary significantly depending on its location in the brain.

What Percentage of the Population Has a Brain AVM?

Brain arteriovenous malformations (AVMs) are among the less common neurovascular disorders, with an estimated prevalence affecting approximately one in 100,000 people each year. AVMs are congenital, meaning individuals are born with these vascular anomalies or they develop during childhood. They result from abnormal development of blood vessels in the brain during the embryonic or fetal stage. This congenital nature underscores the fact that AVMs are not acquired later in life due to lifestyle or environmental factors but are present from birth or from an early age.

It’s important to note that studies have not shown significant demographic or geographic variations in the prevalence of AVMs. They appear to affect individuals of all ethnicities and geographic locations at similar rates. However, the presentation and diagnosis of AVMs may vary widely among individuals, influenced by factors such as the size and location of the AVM and the presence of symptoms.

Life Expectancy of Someone with AVM

Life expectancy for individuals with AVMs varies widely and depends on various factors including the size and location of the AVM, whether it has bled, and the patient’s overall health. With modern treatment modalities, most individuals with brain AVMs can have a normal or near-normal life expectancy, particularly if their AVMs are successfully treated before any bleeding occurs.

How Do You Treat Brain AVMs?

Addressing brain AVMs is a complex process; one tailored to the individual. It most often involves a multidisciplinary team of specialists at neurovascular centers, such as our experts at New Jersey Brain and Spine (NJBS). Treatment options include the following.

• Surgical Resection: Removal of the AVM through open brain surgery, which is most effective for AVMs located in accessible areas of the brain and results in an immediate cure.
• Endovascular Embolization: Minimally invasive technique using catheters to deliver agents that block the blood vessels feeding the AVM. Embolization can reduce the size of an AVM, making it safer for surgical removal or radiation treatment. Some patoients can be cured with embolization alone.
• Stereotactic Radiosurgery: Uses a one time dose of focused radiation to close off the abnormal vessels, a non-invasive option suitable for deep or surgically inaccessible AVMs. There is minimal risk and there are no incisions. Brain AVMs usually take 2-3 years to completely respond to radiation treatment.

Our vascular neurosurgeons are seasoned experts in all three treatment modalities: surgery, embolization and radiation treatment. This is a significant advantage to our patients, as we can precisely tailor each patient’s treatment options specifically to their condition. This has been instrumental in delivering our patients the best possible outcome with the lowest possible risk.

What Is the Survival Rate of a Brain AVM?

The survival rate for individuals with brain AVMs varies—with factors such as the AVM’s size, location, and whether it has caused bleeding influencing outcomes. With appropriate management, the prognosis can be favorable. The multidisciplinary approach at neurovascular centers like NJBS significantly enhances the survival rate and quality of life for AVM patients by offering comprehensive, coordinated care tailored to each patient’s unique condition.

Can AVM Be Cured?

The goal of AVM treatment is usually to completely cure the AVM. AVMs can be completely cured if they are completely removed or otherwise obliterated with embolization or radiosurgery. The possibility of cure depends on the AVM’s size, location, and the treatment modalities used. Some patients may require a combination of treatments to achieve a cure. It’s important to have an in-depth conversation with the neurovascular neurosurgeon in order to set clear expectations about whether or not cure is obtainable.

Is a Brain AVM Considered a Disability?

Whether a brain AVM is considered a disability depends on its effects on the individual. For some, AVMs may cause significant neurological deficits that could classify as a disability, affecting their ability to perform daily tasks or maintain employment. For most patients, especially if the AVM has not bled, there is usually little to no impact on their daily functioning and quality of life.

Critical Role of Neurovascular Centers in AVM Management

AVMs represent a significant challenge in neurovascular medicine, requiring a nuanced, patient-specific approach. The role of neurovascular centers, with their multidisciplinary teams, is indispensable in diagnosing, treating, and managing AVMs—offering hope and improved outcomes for individuals affected by this serious condition.