The neurosurgeons and interventional neuroradiologists at Houston Methodist Hospital Neurological Institute Cerebrovascular Center diagnose and treat many kinds of cerebrovascular conditions, including rare arteriovenous malformations of the head, neck, and face (also called extracranial AVMs). AVMs can look very different from one another, depending on whether they affect tiny blood vessels or large arteries.
AVMs are rare vascular malformations—abnormal tangles of blood vessels where direct connections form between arteries and veins, disrupting the natural blood flow. Most AVMs begin in utero (in the womb), or form soon after birth. They can grow with age—or disappear as a child grows. Sometimes AVMs form in adulthood.
Many “birthmarks” are AVMs. Sometimes they are mistaken for a birthmark called a port wine stain (hemangioma). However, the effects of an AVM are sometimes more than cosmetic. Some AVMs can lead to serious health problems. AVMs that have high-volume, high-speed blood flow can cause congestive heart failure. They can also cause deformities that effect vision and swallowing.
AVMs often have a pinkish-blue tint. The color can deepen over time and a mass may begin to grow underneath. Sometimes AVMs can:
In addition to a physical exam, several tests help diagnose AVMs.
If you are diagnosed with an AVM, our team of specialists will work with you to develop a personalized treatment plan.
Treatment for a head, neck, or facial AVM depends on its location and pattern of blood flow. Once diagnosed, your treatment team will learn everything they can about your AVM, and work with you to determine the best treatment option. If your AVM is not disfiguring, nor causing any complications or pain, then your team may suggest keeping a watchful eye on it through periodic testing.
If an AVM is disfiguring, bleeding, ulcerating, or causing pain or complications, then it may be treated with surgery or embolization. Some AVMs can grow deep into craniofacial structures and tissue, which complicates treatment. When that happens, treatment is often aimed at relieving pain or other symptoms, since a complex AVM may not be able to be fully repaired.
Some AVMs can be removed (excised) with surgery. This treatment option is most successful when the AVM can be removed completely. If the AVM can only be partially treated or removed, it is more likely to recur—and may be harder to treat if it does recur.
Sometimes AVMs are treated more effectively by stopping the abnormal flow of blood between the involved arties and veins. This blood flow can be blocked off with metal coils, plugs, or a liquid that hardens on contact with blood (such as a type of surgical glue called Onyx). Embolization can be done by:
After surgery or embolization treatment, you will be taken to a recovery room until you wake up and your vital signs (blood pressure, breathing rate) are stable. Then you will be taken to a regular hospital room or intensive care unit (ICU) room to further recover. Most patients are able to leave the hospital within a day or two.
When you return home, make sure to follow your surgeon’s advice about returning to your normal activities, taking care of the incision site, and watching out for any warning signs such as fever, chills, unusual pain, or bleeding or swelling at the insertion site. You may need to have periodic exams or tests so your doctors can monitor your condition.