Embolization of arteriovenous malformations

Various treatment options

There are various treatment options for AVM of the brain, which can be used alone or in combination:

• Endovascular embolization: In this procedure, the vascular malformation is reached and treated via the arteries and veins after a groin puncture. During the procedure, we insert plastic tubes (catheters) through the femoral artery into the vessels of the AVM and inject an agent that closes the vessels of the malformation. Endovascular embolization is less invasive than traditional surgery. It can either be used alone or as a preparation before other surgical procedures to reduce the size of the AVM or the likelihood of bleeding and make the procedure safer.
• Surgical removal (resection): The AVM can be surgically removed by a neurosurgical procedure, with or without preoperative embolization.
• Stereotactic radiosurgery (SRS): In this treatment, radiation is directed precisely at the AVM. The radiation damages the blood vessels of the AVM and leads to scarring and thus to the destruction of the AVM.
• Conservative treatment: Conservative treatment (without surgery) is also considered as an alternative to invasive methods. This is chosen in certain cases after thorough consideration of the natural risks of the disease compared to the risks/successes of invasive treatment.

Vascular malformation (arteriovenous malformation) in the blood vessels of the head. The AVM is visible as a vascular tangle.

Advantages and disadvantages

• Treating an AVM helps to reduce the risk of brain damage caused by a hemorrhage or stroke. It also helps to prevent a new rupture after a previous hemorrhage.
• However, complications can occur during treatment. These include Cerebral hemorrhage during or after embolization and during microcatheter navigation or cerebral infarction due to occlusion of the normal cerebral vessels.
• The risks of embolization must be assessed individually and are discussed between the patient and the attending physician. The benefits and risks of a treatment are always assessed by an interdisciplinary team of experts.

Procedure

The first step is to make a diagnosis, decide on minimally invasive treatment and discuss it with you during the consultation. This is followed by a prompt treatment appointment, taking into account the urgency of the treatment and your specific wishes.

The hospital stay for the treatment lasts four to six days. You will arrive the morning before the procedure and we will assess the current findings and make the final preparations. We will be happy to answer any final questions. On the day of the procedure, you will be taken from the ward to one of our two operating theaters, where the surgical team will welcome you and perform the procedure.

Aftercare

Immediately after the procedure, you will be examined to make sure that everything went well. You will then be transferred to a specialized monitoring ward, where you will be cared for and monitored until the next day. On the following day, a magnetic resonance examination is performed to assess the results of the operation and rule out complications. Normally you will then return to the normal ward and after a further one or two days you will be able to go home after a specialist consultation. At this last meeting, appointments for check-ups and consultations are also made.