Radiosurgery for AVM: What You Need to Know

Stereotactic radiosurgery (SRS) is a minimally invasive treatment option for arteriovenous malformations (AVMs) in the brain or spine. Radiosurgery treatment delivers a precisely focused high-dose beam of radiation to the AVM, causing the vessels to thicken, scar, and close. Once the AVM is closed, it eventually shrinks and disappears. It’s particularly effective for small to medium-sized AVMs, with high rates (80-90%) of success and low risk of complications.

What Is an Arteriovenous Malformation (AVM)?

An arteriovenous malformation is an abnormal tangle of blood vessels where arteries connect directly to veins rather than through capillaries. Normally, arteries carry heavy flowing oxygen-rich blood to the capillaries, which slow the blood flow as it transfers to the veins. The increased pressure from blood flowing directly from the arteries to the veins can cause bulges in the walls of the veins, which can then rupture and bleed. Identifying and treating a brain AVM early can prevent serious and potentially life-threatening complications.H2: How Radiosurgery Uses Targeted Radiation Therapy to Treat AVMs

Radiosurgery for arteriovenous malformations (AVMs) uses precisely focused radiation beams to gradually close off the abnormal tangle of blood vessels. Radiosurgery works as a form of targeted radiation therapy, where multiple radiation beams are carefully aimed from different angles to target the AVM while minimizing exposure to surrounding tissue. 

NJBS neurosurgeons perform this procedure in a single outpatient session lasting a few hours, and most patients can return to normal activities within a day or two, making it an excellent option for AVMs that are difficult to reach with traditional surgery or located in critical areas of the brain. 

Types of Radiosurgery Used to Treat AVMs

Two types of stereotactic radiosurgery are used to treat AVMs, each of which can be precisely controlled to minimize damage to surrounding brain tissue.

• Gamma Knife Radiosurgery is a treatment that uses radioactive isotopes to create small beams of gamma rays, which are then delivered to the center of the AVM. During the procedure, a patient will have a box-shaped frame secured around the head. This head frame holds the head still and guides the gamma ray beams to the lesion with the aid of a CT scan or MRI. It is typically used for smaller lesions in the brain and upper neck. Often, only one treatment is required.
• Linac-based Stereotactic Radiosurgery is a treatment that uses a machine called a linear accelerator to deliver X-ray beams to the AVM with the aid of advanced imaging techniques. The machine moves around the patient during treatment and can therefore treat larger areas. Treatment with Linac-based SRS may require multiple sessions.

Benefits of Radiosurgery for AVM Patients

AVM radiosurgery treatment is a non-invasive way to treat brain AVMs. Radiosurgery can be used to treat AVMs in areas of the brain that are difficult to reach with traditional surgery. Because anesthesia is not required and there are no incisions, radiosurgery involves a shorter recovery period and avoids the risks associated with traditional surgery. 

Risks and Side Effects

Although the majority of AVM radiosurgery procedures are successful, there are some complications associated with the treatment, which can include:

• Bleeding
• Neurological deficits
• Nausea and fatigue
• Headache
• Incomplete AVM treatment

 Depending on the location of the AVM, some patients may experience mild headaches, fatigue, and nausea or vomiting. These symptoms are often short-term and can be managed with pain medication and rest. There is a risk of temporary or permanent weakness, speech difficulties, or memory problems if radiation damages brain tissue, and bleeding can occur after treatment before the AVM is fully closed. NJBS specialists will carefully evaluate your specific condition to determine if you are a candidate for radiosurgery. You can trust that we will thoroughly discuss all potential risks and complications and provide contingency plans if complications arise.

Success Rates and Recovery

Stereotactic radiosurgery for brain AVM treatment has shown high success rates, ranging from 80%-90%; however, rates can vary depending on the size and location of the AVM, as well as other patient-specific factors like age and health.

The obliteration rate, which is the percentage of AVMs fully closed after treatment, can vary depending on the size, location, and complexity of the malformation, but studies often report rates between 70–90% within 3 years.

Case Study: A Patient Successfully Treated with Radiosurgery for Brain AVM 

Jeff, a 28-year-old physical therapist presented to the emergency room following a sudden severe headache and brief loss of consciousness. CT imaging revealed a small hemorrhage in the right parietal lobe, and subsequent MRI angiography identified a 2.25 cm arteriovenous malformation. 

After evaluation, an NJBS neurosurgeon with significant expertise in aneurysm, AVM, and stroke treatment, determined that the AVM’s location made open surgical resection too risky. After discussing treatment options with Jeff and his family, they decided to proceed with stereotactic radiosurgery.

Over the following months, MRI scans showed progressive obliteration of the abnormal blood vessels. Jeff returned to work without restrictions. At his two-year follow-up, angiography confirmed complete AVM obliteration, and Jeff was cleared for all normal activities and is thriving. 

[name and details have been changed to preserve patient anonymity]

Who Is a Candidate for AVM Radiosurgery?

Radiosurgery may be recommended for AVMs that are small to medium in size or located in a region of the brain that is more difficult to reach through traditional surgery. Radiosurgery may also be recommended if a person isn’t a good candidate for traditional surgery due to other health conditions or to reduce the size of a larger AVM before traditional surgery is performed. 

If you or a loved one has been diagnosed with an arteriovenous malformation and you are considering treatment options, contact New Jersey Brain and Spine today. Our experienced physician team has delivered highly skilled and compassionate care to more than 40,000 patients with complex brain, spine, and neurological conditions.