Arteriovenous Malformations (AVMs) in the Brain or Spine

Arteriovenous Malformations (AVMs) in the Brain or Spine

And Cavernous Malformations, Dural Spinal Fistulas

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Duke neurosurgeons combine sophisticated imaging and extensive surgical experience to treat arteriovenous malformations (AVMs) -- rare abnormal connections between arteries and veins that can occur in the brain or spine. We also treat other blood vessel abnormalities, including cavernous malformations (tangled and weakened capillaries that can leak blood) and dural spinal fistulas (abnormal openings that occur in the dura, the leather-like cover over the brain and spinal cord).

In general, vascular malformations can occur anywhere in the body. Some vascular system defects in the central nervous system can remain stable for years or a lifetime, while others can interfere with blood circulation and increase your risk of hemorrhage, seizure, and stroke. Our experienced neurosurgeons use a combination of the latest minimally invasive and noninvasive approaches to repair the problem and prevent or reduce your risk for serious complications.

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The size, type, location, and status of this type of vascular malformation will determine the best treatment options. Patients can also choose a watchful waiting approach.


May be prescribed to treat symptoms -- including headache, back pain, and seizures -- caused by AVMs.

Endovascular Coiling or Embolization

A catheter is inserted through a small incision (usually in your groin), threaded to your brain, and used to place coils, glue, or plugs to block blood flow within an AVM or dural spinal fistula. This procedure may be done in combination with radiosurgery.

Surgical Resection

Surgeons create an opening in the skull (a craniotomy) with computer imaging guidance (usually MRI based). Using a high-power microscope, surgeons remove the AVM and cauterize (or burn) its feeder blood vessels. Complete removal is confirmed with cerebral angiography. This procedure can provide immediate cure, eliminating the risk of future bleeding, and it is often the preferred option for ruptured AVMs.

Stereotactic Radiosurgery

Computer imaging is used to guide a single high dose of radiation directly to the AVM. No incision is required. This procedure is typically used for AVMs that cannot be reached by surgery.

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Cerebral Angiography

Through a small incision, a catheter is inserted into a large artery and threaded through the circulatory system to the brain. Then a contrast dye is injected to capture images that allow neuroradiologists (specialists in the nerves found in the brain and spine) to view abnormal connections within arteries and veins and help plan the appropriate treatment. Overall, this test takes about an hour and requires you to lie flat afterward for two to four hours.

MRI and CT Scans

Three-dimensional images of the brain and its blood vessels are studied to analyze malformations that may be at risk for bleeding or rupture. These tests take about 30-60 minutes, and are virtually painless. When MRI or CT scans are used to examine blood vessels (angiograms), they are called MRAs and CTAs.

Functional MRI

Similar to standard MRI, this test creates a map of brain activity to assess the risk of brain surgery and plan a surgical approach that minimizes impact and preserves function. This test also takes about 30-60 minutes and is virtually painless.

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Why Choose Duke

Our neurosurgeons use high-magnification microscopes and high-resolution imaging to remove AVMs and repair fistulas while minimizing damage to surrounding areas and neurological structures within the brain and spine.

Emergency Diagnosis and Response
Many cerebrovascular diseases aren’t diagnosed until after a serious complication occurs. Our team is the region's leading resource for brain health emergencies, including stroke. Speed of treatment is critical for recovery, and our policies and processes for stroke care have been recognized by The Joint Commission.

Advanced Training and Experience
Our highly specialized physicians and surgeons have completed additional years of training for AVM treatment and are experts in their fields. Blood-flow disorders in the brain can be difficult to diagnose, but our specialists have the advantage of doing so regularly.

Less Invasive Therapies
We are experts in minimally invasive techniques that repair veins and arteries, reduce brain bleeding, and resume healthy blood flow. These options have less risk than traditional open surgery and are much better tolerated.

Leading Referral Center
People with AVMs and similar issues are referred to Duke from far and wide for us to confirm a diagnosis, consult on complex cases, and care for patients who have been turned away elsewhere.

A Team Approach
Our medical team includes specially trained radiologists who capture and interpret images of blood vessels in your brain, neurosurgeons who regularly perform procedures to reduce or eliminate cerebrovascular disturbances, and other highly trained specialists. We work together to create the treatment plan that's best for you.

Diagnostic and Imaging Expertise
We use the latest diagnostic and imaging technologies quickly and effectively. These tools enhance our ability to review your medical situation and present the safest and best treatment options.

Duke University Hospital is nationally ranked in 10 adult specialties
Best Neurology, Neurosurgery in North Carolina
When it comes to your care, you want the very best. Duke University Hospital's nationally ranked neurology and neurosurgery program was named best in North Carolina by U.S. News & World Report for 2019–2020.
Reviewed: 10/17/2019