Duke's Cerebrovascular Center offers advanced treatments for arteriovenous malformations (AVM).

An AVM is an abnormal collection of blood vessels where blood flows from the arteries directly into the veins, bypassing the capillaries altogether.

When in the brain, AVMs often create large flows of blood that build in pressure, placing a patient at risk for seizures, hemorrhage, neurological injury, and even death.

Diagnosis

AVMs are diagnosed either incidentally with CT or MRI scans or after a hemorrhage or seizure. Patients at Duke usually undergo an angiogram to better define the AVM and determine if associated cerebral aneurysms are encountered.

Treatment

At Duke, we treat AVMs with embolization, radiation, surgery, or a combination of these methods. To prevent a hemorrhage, the AVM must be completely eliminated.

Each treatment has advantages and disadvantages, and your team of doctors will consult and decide which treatment option is best for your situation. 

Embolization

Embolization is a method of plugging the blood vessels of the AVM through a simple groin puncture. Using specialized angiography with road-mapping techniques, a microcatheter is placed within the feeding vessels of the AVM.

Once the area is reached, a number of substances such as glue, onyx, or even a wire coil is placed to block off the abnormal blood vessels without damaging normal blood vessels.

We continually update and change our embolization methods in order to use the most current tools and techniques and to ensure our patients receive the safest, most effective care.

Microsurgical Resection

With a microsurgical resection, your surgeon will perform a craniotomy under a high-magnification operating microscope.

Our team of sophisticated neuroanesthesiologists will oversee the anesthesia, and neurophysiologists will be on hand to monitor your brain activity. Patients frequently undergo intraoperative angiographic evaluation to ensure adequacy of the AVM removal.

Stereotactic Radiosurgery

Stereotactic radiosurgery is the precise delivery of a single, high dose of radiation that specifically targets the AVM. 

Radiosurgery either alone or in combination with embolization techniques is often used in patients with complex, deep-seated or brain-stem AVMs which would be difficult to safely treat surgically. Radiosurgery is most successful in AVMs that are fewer than three centimeters in diameter.

This does not require a craniotomy and is performed as an outpatient procedure. 

Before and After

The following images show how brain AVMs appear in the brain before and during surgery. 

A 37-year-old man suffered a seizure. An MRI scan was done to diagnose the problem.

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MRI revealed he had a brain arteriovenous malformation (AVM).

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After carefully evaluating his case, doctors performed selective embolization of the AVM followed by surgical resection. He has had no more neurological problems since the surgery.

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Appointments

For information about scheduling an appointment with a specific doctor, visit the Contact Us page.

Physicians

Physicians offering this service include:

• Britz, Gavin W.
  • Surgery / Neurosurgery
• Enterline, David S.
  • Radiology / Neuroradiology
  • Radiology / Neurointerventional Radiology
• Kirkpatrick, John P.
  • Radiation Oncology / Radiation Oncology
• Smith, Tony P.
  • Radiology / Vascular and Interventional Radiology
  • Radiology / Neurointerventional Radiology
• Zomorodi, Ali R.
  • Surgery / Neurosurgery

Locations

This service is available at:

• Duke Health Center at Morreene Road (Neuroscience)
  932 Morreene Road, Durham, NC 27705
• Duke Neurosurgery of Raleigh
  3480 Wake Forest Road, Suite 558, Raleigh, NC 27609
• Duke University Hospital
  2301 Erwin Road, Durham, NC 27710