Arteriovenous Malformations (AVMs) of the Head, Neck, and Face

At Houston Methodist, our neurosurgeons and interventional radiologists diagnose and treat many kinds of cerebrovascular conditions, including arteriovenous malformations (AVMs) of the head, neck and face. 

AVMs are rare, abnormal tangles of blood vessels in which connections form between arteries and veins directly (bypassing capillaries), disrupting the natural blood flow. AVMs can be congenital (present at birth) or may form during adulthood; they may also grow or disappear with time. The appearance of the AVM depends on the size of the blood vessel involved. The affected area may have a pink-blue tint, which can darken over time. You may feel some warmth in the area and the site may be painful. It may also pulse, ulcerate or bleed.

Extracranial AVMs exist outside the skull and intracranial AVMs occur inside the skull. Intracranial AVMs may affect blood flow directly to the brain and could cause stroke. AVMs also may cause congestive heart failure if large amounts of blood flow rapidly through them. Deformities that can affect your vision and ability to swallow may also result from an AVM.

Diagnosis of Arteriovenous Malformations of the Head, Neck and Face
Your physician will perform a physical exam and may order one or more of the following diagnostic imaging tests.

• A Duplex or Doppler ultrasound uses sound waves to image your blood vessels and measure your blood-flow speed. 
• Computed tomography angiogram (CTA) uses a contrast agent (dye), which is injected into your vessels, to look for abnormalities. CT scans that do not use dye may also be taken of your head and neck.
• Magnetic resonance angiography (MRA) combines an injected contrast agent (dye) with magnetic and radio waves to create 3-D cross-sections of the arteries in your neck and brain. An MRI (without dye) creates images of your head and neck.
• In a catheter angiogram, the surgeon inserts a thin catheter through your groin and threads it into your carotid arteries; a contrast agent (dye) is injected to help clinicians visualize the arteries on X-rays.

Our team will work with you to develop a personalized treatment plan.

Treatment Options for Arteriovenous Malformations of the Head, Neck and Face
Finding the best treatment option for an AVM depends on its location and pattern of blood flow. If your AVM is not disfiguring or causing complications or pain, your team may suggest observation. If it is disfiguring, bleeding, ulcerating or causing pain or discomfort, you may be advised to undergo surgery or embolization.

The surgery (or excision) option is most successful when your AVM can be removed or treated completely; if your AVM cannot be completely removed by surgery, it may recur and be more difficult to treat.

AVMs may also be managed by embolization, a treatment in which the abnormal blood flow between the arteries and veins is blocked with use of metal coils, plugs or an embolizing liquid such as surgical glue. Embolization is done by directly injecting an embolizing  liquid into the AVM or by feeding a catheter through a vessel to the AVM and then placing the blocking device.

Recovery and Rehabilitation From Treatment for AVM of the Head, Neck and Face
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 moved 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.

Our team will instruct you on proper home care and follow-up visits after your treatment procedure. When you return home, make sure to follow your surgeon’s advice about returning to  normal activities, taking care of the incision site and watching for any signs of infection, 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.