Pediatrics

Pediatric Neurology and Neurosurgery

Arteriovenous Malformations

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The most common vascular brain malformation in children

Cerebral arteriovenous malformations (AVMs) are abnormal tangles of blood vessels that develop in the brain. They are the most common vascular malformations of the brain in children. The team of pediatric neurovascular specialists at NewYork-Presbyterian Komansky Children’s Hospital and NewYork-Presbyterian Morgan Stanley Children’s Hospital provide customized care with compassion and expertise for children with AVMs. Our goal is to treat the AVM and eliminate the chance of recurrence.

Signs & symptoms

In four out of five children, the AVM is first detected when it ruptures, causing bleeding in the brain. The remaining 20% are found when a child is being evaluated for seizures or when a brain MRI is done for another reason. Patients who have a ruptured AVM may experience:

  • Sudden onset of headache or seizures
  • Loss of consciousness or diminished alertness
  • Weakness or numbness in part of the body
  • Aversion to bright light
  • Double vision, vision loss, or other vision changes
  • Confusion or irritability
  • Neck and shoulder pain, or a stiff neck
  • Nausea and vomiting

Diagnosing AVMs

An AVM is often diagnosed using MRI scanning and confirmed with an angiogram. An angiogram is the gold standard for diagnosing and evaluating AVMs. To perform an angiogram, a specialist called an interventional neuroradiologist inserts a catheter (a small plastic tube) into a blood vessel. It feeds it gently toward the location of the suspected AVM. A special dye injected through the catheter can be seen on an x-ray as it makes its way to the malformation. Angiography enables the neuroradiologist and neurosurgeon to locate the AVM precisely within the brain.

Our approach to care

NewYork-Presbyterian offers multiple approaches for children with these malformations in the brain. The goal of treatment is to remove the AVM in the safest way. Children with brain AVMs may have a predisposition to these vascular malformations, so our physicians perform a comprehensive evaluation of your child's health to look for any larger, systemic problems that may increase the risk of future AVMs. Because pediatrics AVMs can recur, we continue to monitor your child after treatment.

Arteriovenous malformation treatment

Your doctors will let you know which treatment is best for your child.

Surgery is the most immediate treatment. The AVM can be completely removed and is considered cured. At NewYork-Presbyterian, we perform angiography during AVM surgery while your child is still under anesthesia. This confirms if we have removed the entire AVM or if we need to perform additional surgery under the same anesthetic.

Embolization is an interventional neuroradiology technique that uses a kind of liquid "glue" to block blood flow to the malformation, restoring normal circulation. There is a high rate of recurrence of the AVM when only this treatment is used. It is more often used to block off the abnormal blood vessels before surgery to reduce the risk of hemorrhage, and the area where the glue collects also makes it easier for the surgeon to see the AVM to be removed.

Radiosurgery is an outpatient treatment that employs a single high dose of radiation applied with pinpoint precision to target deep-seated AVMs residing in vital areas that may be challenging to treat with conventional surgery. Younger children may receive several smaller radiation doses over multiple visits to reduce the risk of tissue damage. The radiation results in a slow narrowing of the abnormal blood vessels; it could take up to three years for the AVM to completely resolve.

Why choose us

NewYork-Presbyterian brings together the expertise of a team of pediatric neurosurgeons, pediatric neurologists, and interventional neuroradiologists — and some doctors who are dual-trained in neurosurgery and interventional neuroradiology — to select and provide the most effective care for each child with an AVM. This combination of talents can be challenging to find at most children's hospitals.