Arteriovenous Malformations (AVMs) in the Brain or Spine

And Arteriovenous Fistulas, 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 arteriovenous fistulas (when blood flow bypasses some capillaries) and dural spinal fistulas (abnormal openings that occur in the dura, the leather-like covering of the brain and spinal cord).

In general, vascular malformations like these 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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Tests

Cerebral Angiography

Through a small puncture in the wrist or groin, a catheter is inserted into a large artery and threaded to arteries or veins leading to the brain. A contrast dye is injected to capture images that allow neurosurgeons and neurointerventional radiologists to view abnormal connections within arteries and veins, pinpoint high-risk areas, and identify appropriate treatment options.

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. 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 help doctors assess the risk of brain surgery and plan a surgical approach that minimizes impact and preserves function.

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Treatments

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

Medication

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 puncture (usually in your groin) and threaded to your brain. Coils, glue, or plugs are placed through the catheter to block blood flow within an AVM or fistula. This procedure may be done in combination with stereotactic 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 an immediate cure by 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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Why Choose Duke

Microsurgery
Our neurosurgeons use microsurgical techniques and equipment, including high-magnification microscopes and high-resolution imaging, to remove AVMs and repair fistulas. This minimizes 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 -- an independent, accrediting organization recognized for its quality standards in health care.

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 restore 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 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.

Best Hospital for Neurology, Neurosurgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our neurology and neurosurgery program is nationally ranked, and the highest-ranked program in North Carolina by U.S. News & World Report for 2024–2025.

This page was medically reviewed on 04/25/2022 by

Andrew B. Cutler, MD, MS | Neurosurgeon