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Brain AVM Radiosurgery


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Johns Hopkins Brain AVM Radiosurgery

Email Dr. Jeffery Williams. The decisions related to treatment for the brain AVM (arteriovenous malformation) depend upon the complete understanding of the competing risks vs. benefits. The important considerations for treatment of the AVM include the size and location within the brain. Options for treatment include brain AVM surgery, brain AVM embolization and brain AVM radiosurgery.

Arteriorvenous Malformations of the Brain: Click Here for Dr. Williams C.V. Curriculum Vitae:Dr. Jeffery Williams
Director, Stereotactic Radiosurgery
The Johns Hopkins Hospital
Board Certified: Neurological Surgery
Board Certified: Radiation Oncology
Email Dr. Jeffery Williams.


Email Address: jw@jhu.edu
Phone: 410-614-2886
Fax: 410-614-2982



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Brain AVM Treatments

Brain AVM (Arteriovenous Malformations) require different treatments depending upon many factors.

Brain AVM Hemorrhage

The most neurologically devastating presentation associated with arteriovenous malformations (AVMs) of the brain is intracerebral hemorrhage. Numerous studies have estimated the natural risk of intracerebral hemorrhage associated with AVMs at 3% to 4% per year. When an AVM is identified in a young, otherwise healthy individual, one of several therapies (microsurgery, radiosurgery, or endovascular therapy) is often considered in an attempt to extirpate the lesion before a hemorrhage can occur.

Brain AVM Natural History

Many studies have addressed the issue of the natural history of AVMs. Unfortunately, most have selection bias, the use of a variety of therapeutic techniques, relatively short follow-up duration, and the inclusion of only certain subgroups of AVM patients, such as patients presenting with hemorrhage.

Brain AVM Bleeding

Some have suggested that a history of hemorrhage predisposes a patient to an increased incidence of subsequent hemorrhages. A number of investigators have identified a tendency for smaller AVMs to hemorrhage. Others that this is an artifact due to the fact that smaller lesions are less likely than larger AVMs to present with seizures or vascular steal. Likewise, an increased risk of hemorrhage during pregnancy has been postulated but never proven.

Brain AVM Risk Factors

A variety of angiographic abnormalities have been purported to increase the likelihood of AVM hemorrhage. These include irregularity or stenosis of venous drainage, or absence of the vein of Galen for cases with deep drainage. Arterial aneurysms or venous stenosis are present in many patients presenting with hemorrhage. Periventricular location, intranidal aneurysm, and central venous drainage have been corrleated with the occurrence of AVM hemorrhage.

Brain AVM Treatments

Treatments include stereotactic radiosurgery, surgery and/or embolization (alone or in combination)

AVM radiosurgery offers non-invasive treatment. The treatment includes placement of the radiosurgery frame via local anesthetic. The radiosurgery frame attaches to the scalp and to the outer table of the skull. The frame is in place during the angiogram. The AVM and the frame are visualized during the angiogrm. The precise location of the AVM in the brain is determined by reference to the visible frame, using a powerful computer.

Selected patients with arteriovenous malformations (AVMs) are candidates for treatment with radiosurgery, and in the majority of cases a cure can be achieved.

Large AVM

For larger AVM the combination of embolization and radiosurgery has proven useful. The embolization can reduce the size of the AVM such that radiosurgery is feasible. The radiosurgery for larger AVM may require 2 to 3 sessions, rather than one, to be successful. This is because the size of the treated AVM is larger and therefore requires a decreased dose to render a safe treatment. The decreased dose implies multiple treatments in order to achieve success. The decision regarding AVM treatments should be made in the context of the risks and benefits of the competing treatments. These vary with the size and location of the AVM within the brain.


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Your email address (if response is desired):


Please enter the AVM responses and click on the "Submit Form" button at the end of this form.


  • Type of Vascular Malformation:
    Please list the type of vascular malformation:

    AVM (Arteriovenous Malformation)

    Cavernous Angioma

    Other (not listed above):



  • What is the first date of the diagnosis of the AVM?




  • How was the first AVM diagnosed?

    Craniotomy

    Only radiographically



  • What was the location of the AVM?

    Lobar (Frontal, temporal, parietal, occipital)

    Deep (brainstem)

    Cerebellar



  • What is the size of the AVM (largest dimension)?

    Less than one centimeter

    Greater than one, but less than two centimeters

    Greater than three centimeters



  • Is the AVM venous drainage DEEP or SUPERFICIAL?

    Deep

    Superficial




  • Does the patient have the following syndromes?

    Renal (Kidney) Abnormality

    Von-Hippel Lindau Disease



  • How was the first AVM treated?

    Observation Only

    Subtotal Resection

    Total Resection



  • What was the DATE of the treatment for the FIRST AVM?



  • What is the DATE of the DIAGNOSIS of the CURRENT AVM (if current is different from above)? This AVM is for consideration for the CURRENT radiosurgery or surgical resection.



  • How many AVM are there now?

    One

    More than one.





  • Prior to Radiosurgery, how is the CURRENT AVM (or group of AVM) surgically treated?

    Subtotal Resection

    Total Resection

    No Surgery



  • This completes the AVM Registration Page. Thanks for completing the form. If helpful to you, please send the form as shown below.

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