Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Head and Neck Arteriovenous Malformation

Appointments

Head, Neck, and Facial Arteriovenous Malformations (AVMs)

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.

Overview

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.

Symptoms

AVMs often have a pinkish-blue tint. The color can deepen over time and a mass may begin to grow underneath. Sometimes AVMs can:

  • Feel warm
  • Be painful
  • Pulsate
  • Ulcerate
  • Blee

Diagnosis

In addition to a physical exam, several tests help diagnose AVMs.

  • Duplex or Doppler ultrasound uses sound waves to show your blood vessels and measure how fast your blood flows. It can help determine where there are any problems in your blood vessels.
  • Computerized tomography angiogram (CTA) uses a contrast (dye) to highlight your blood vessels. First a dye is injected into a blood vessel, then CT images are taken of your head and neck to look for abnormalities.
  • Computerized tomography (CT) scans that don’t use contrast may also be taken of your head and neck.
  • Magnetic resonance angiography (MRA) combines contrast with magnetic and radio waves to create cross-sectional and three-dimensional images of arteries in your neck and brain.
  • Magnetic resonance imaging (MRI) creates images of your head and neck without using contrast.
  • Catheter angiogram is a procedure where the surgeon inserts a thin catheter through the groin and threads it into your carotid arteries. Contrast is then injected through the catheter to help the arteries show up on detailed X-rays.

If you are diagnosed with an AVM, our team of specialists will work with you to develop a personalized treatment plan.

Treatment Options

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.

Surgery

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.

Embolization

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:

  • Directly injecting an embolizing liquid into the AVM.
  • Performing an endovascular embolization by feeding a tiny catheter through a blood vessel (usually in the groin) to the vessels that supply blood to the AVM. Then, the blocking agent (coil, plug, or liquid) is placed through the catheter.

Recovery and Rehabilitation

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.

Additional Resources

Medscape
MedicineNet.com
AVM Survivors Network