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Medications for Arteriovenous Malformation

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The treatment of brain arteriovenous malformations (AVM) is complex. Definitive treatment of an AVM is typically provided via surgery, sometimes in combination with endovascular embolization or radiosurgery (radiation). Medications may be prescribed to manage symptoms such as headaches and seizures, but there are currently no approved medications for the direct definitive treatment of an AVM.

Can AVMs Be Treated Without Surgery?

Surgery offers the best chance at curing an AVM; however it is not the only treatment option available. Although endovascular embolization and radiosurgery are typically used in combination with surgery, they can be used alone if surgery is deemed too risky. Without surgery, however, the cure rates become less likely.

Another option is to receive no treatment and undergo regular observation. This may be favorable in cases where an AVM is incidentally found and has a low cumulative risk of rupture. However, it is important to note that the AVM will not go away on its own.  

Medications may be administered to address symptoms such as headaches and seizures, but there are no specific medications that can directly treat the AVM. Research on medications in the treatment of AVMs is still ongoing, though surgery will likely remain the preferred treatment modality if deemed safe and feasible. If surgery is not possible but patients are experiencing severe symptoms such as seizures and neurological deficits thought to be caused by the AVM, palliative endovascular embolization or radiosurgery are other treatment options that may be discussed.

The thought of surgery can be terrifying, but this may be an essential part of your journey towards a cure. Although certain symptoms may be temporarily alleviated by pain-relief or anti-seizure medications, persistent symptoms should be discussed with your physician. An initial decision to pursue observation rather than surgery or other treatment options can always change. Communicating your goals of treatment is critical to ensure that the treatment plan aligns with your preferences and values.

What Is the Treatment if an AVM Ruptures?

Once an AVM ruptures, the risk of future rupture increases nearly four times and peaks in the first year. As a result, the decision to pursue medical management and observation versus obliterative treatment can change. After rupture, the treatment and timing of treatment depends on characteristics of the patient (age, general health, presence of other medical conditions, neurological status) and AVM (size, location, blood vessels involved).

If an AVM ruptures but the patient is neurologically stable, surgery is an option that can be pursued electively, when possible. If an AVM rupture causes a life threatening condition, surgery is performed emergently to evacuate the blood and remove the AVM if safe and feasible. 

There are many “ifs” that are considered during the management of an AVM. Since all treatments come with their own risks, physicians must weigh these risks against that of the natural course of an AVM. Of particular concern is the risk for an AVM to rupture or bleed into the brain, as this can cause a life threatening condition and long-term neurological consequences in a subset of patients. 

Treatment plans can change as new circumstances arise. Optimal management of an AVM requires shared decision making with your care team. You should not hesitate to ask questions about any aspect of your care.

Key Takeaways

  • AVMs can be treated with observation and medical therapy if it is determined that the risk of definitive therapy poses more danger to the patient than than the risk of AVM rupture.
  • All AVMs are unique, and some have morphological characteristics that increase or decrease the risk of rupture. Consideration of these factors can guide treatment decisions.
  • Ruptured AVMs are at a higher risk of subsequent rupture than those that have never ruptured. This can change treatment decision making.