We typically first find the AVM in a CT scan or, more commonly, in an MRI scan. If we find an AVM by CT or MRI scan, we then obtain an angiogram or arteriogram. At this point, the angiogram is the test that most accurately shows the AVM and its relationship to the surrounding arteries and veins. Microsurgical resection is the more established of the three techniques. During microsurgical resection, we perform a craniotomy and using the microscope remove the AVM from the brain or spinal cord.
Stereotactic radiotherapy is a more recent technique for the treatment of AVMs.
During stereotactic radiotherapy, we deliver a concentrated dose of radiotherapy to the core of the AVM in one session. Over the course of 2 to 5 years, the vessels of the AVM clot off and the AVM shuts down. Endovascular embolization is also a more recent technique for the treatment of AVMs. It is typically used in preparation for either microsurgical resection or stereotactic radiotherapy. During endovascular embolization, we pass a catheter through the groin up into the arteries in the brain that lead to the AVM and inject a material into these arteries.