Arteriovenous Malformations (AVMs) in Adults
An arteriovenous malformation is a condition most people have never heard of — until the day it becomes impossible to ignore. For the majority of adults living with an AVM, there are no symptoms for years, sometimes decades. Then a seizure, a severe headache, or a neurological event brings everything to the surface. In some cases, an AVM is found entirely by accident on imaging done for something else, leaving patients with a diagnosis they weren’t expecting and questions they urgently need answered.
At Advanced Neurosurgery Associates, we specialize in guiding adult patients through exactly this experience — from an unexpected diagnosis to a clear, evidence-based plan — at four locations across New Jersey in Rutherford, Jersey City, New Brunswick, and Morristown.
What Is an AVM?
An arteriovenousc malformation is an abnormal tangle of blood vessels in which arteries connect directly to veins, bypassing the capillary network that normally regulates blood flow and pressure. The result is a high-pressure, fragile cluster of vessels — called a nidus — that is prone to rupture and bleeding into or around the brain or spinal cord.
Most AVMs are congenital, meaning they form during fetal development. However, the majority of people with an AVM have no symptoms during childhood. Symptoms most commonly emerge between the ages of 35 and 40, making AVMs fundamentally a condition of adult life. Bleeding from a brain AVM is the leading cause of hemorrhagic stroke in young and middle-aged adults — a fact that underscores why expert evaluation and a thoughtful treatment plan matter so much.
How Common Is AVM in Adults?
AVMs affect men and women equally and show no predisposition for specific ethnic groups. Only about 12% of AVMs ever become symptomatic, but those that do carry significant risk of life-altering neurological consequences. Women should be aware that pregnancy — with its associated increases in blood volume and pressure — can sometimes trigger symptoms in a previously silent AVM.
Symptoms in Adults
AVM symptoms in adults vary considerably depending on whether and where bleeding has occurred. Many adults are entirely asymptomatic. When symptoms do arise, they may include:
- Sudden, severe headache — often the first sign of hemorrhage
- Seizures, which may be the presenting symptom in adults with no prior history
- Weakness, numbness, or paralysis on one side of the body
- Speech or language difficulties
- Vision disturbances or loss
- Balance and coordination problems
- A pulsing or rushing sound in the head (bruit), caused by high-velocity blood flow through the AVM
- Progressive cognitive or memory changes in some cases
Epilepsy Surgical Evaluation
Certain diagnostic tests may be performed to determine if surgery would be an effective treatment. This surgical evaluation can involve a number of tests to develop the diagnosis of the cause and location of the epileptic seizures.
Evaluation prior to surgery for epilepsy has changed radically in the past few decades, most notably since the advent of long-term video-electroencephalography (EEG) monitoring in the late 1970s, and advanced neuroimaging, specifically with the additional use of MRI.
Epilepsy Testing and Diagnosis
To develop the epilepsy diagnosis before surgery, patients partake in extensive testing, such as:
- Electroencephalogram (EEG), which helps identify the seizure focus
- Magnetic Resonance Imaging (MRI), the “gold standard” for locating and evaluating brain lesions
- Functional MRI (fMRI), which creates a “road map” of brain functions
- Single-photon Emission Computer Tomography (SPECT) to explore where the seizure starts and its spread patterns
- Intracarotid Memory and Speech Evaluation (Wada test), a test of language and memory functions.
- Both before and during surgery, tests may be performed to map motor, sensory, language and memory functions; such as functional brain mapping and awake craniotomy.
It is also important to consider the emotional effects. Neuropsychology and psychiatry are a vital part of ANA’s epilepsy team’s evaluation.
EEG & Video Monitoring
Electroencephalography (EEG) is the fundamental measure of identifying seizure focus. The epileptologists on our team are adept at reading the spikes and sharp waves that constitute a spectrum of shifting seizure focus. Most patients undergoing evaluation for surgery will require EEG with video telemetry to document the seizure pattern.
However, an appropriate focus goes beyond single readings. Our experts evaluate EEG monitoring over a period of time. This is a critical measure to determine a clear onset and location of seizure activity.
MRI
While computerized tomography (CT) scan can provide some useful information about lesions which may be causing seizures, the “gold standard” for locating and evaluating brain lesions is magnetic resonance imaging (MRI). The greatest advance of MRI technology for epilepsy is the incredible clarity of both the normal and pathological anatomy of the brain. Since the mid-1980s, this technology has allowed us to routinely identify lesions that were previously undetectable.
Functional MRI (FMRI)
Magneto-Encephalography
Nuclear Imaging
Nuclear medicine, which deals with imaging the body for both diagnostic and treatment purposes, plays an important role in the pre-surgical assessment of patients with refractory epilepsy. This is evident in the case of single-photon emission computed tomography (SPECT) which is used to determine the seizure onset zone.
SPECT (single proton emission computed tomography) has an important role in the investigation of surgical candidates. Ictal (meaning taking place during a seizure) SPECT has also been useful to study seizure-spread patterns. Blood flow increases in the brain area in which the seizure originates and the blood flow can become less than normal in that same area during non-seizure states. By injecting a small and safe amount of a radioactive substance into a patient’s blood stream via IV we can evaluate the blood flow in the brain at a given time. Changes in blood flow during and after a seizure can be helpful in localizing seizure focus and spread patterns.
Neuropsychology
Diagnosis
Adult AVM evaluation begins with a thorough neurological history and examination, followed by advanced neuroimaging. The standard diagnostic pathway includes MRI to identify the AVM’s location, size, and relationship to surrounding brain structures, and cerebral angiography (DSA) — the gold standard — which provides a precise, real-time map of blood flow through the malformation and is essential for both diagnosis and treatment planning.
CT angiography and MR angiography may also be used to characterize the AVM and assess for associated aneurysms, which are present in a meaningful proportion of adult AVM cases and can independently elevate bleeding risk.
Medication
At least half of those newly diagnosed with epilepsy will become seizure-free with their first medication—if they take it regularly and as prescribed. The efficacy of these medications of course depends on the type and severity of the epilepsy. In some cases, medication may diminish but not completely control all seizure activity.
Many various types of anticonvulsant (also called antiepileptic) drugs are available. Some patients respond to one drug and some may need more than one. It may take several months before the best drug and dosage are determined. Patients are monitored throughout the medication process via blood tests.
Diet
A ketogenic diet, one which supplies the majority of calories from fat as opposed to glucose, mimics the body’s response to starvation by burning fat for energy. Scientists are not precisely sure why this diet prevents seizures, although it is being studied. Estimates vary from 10-30% of children who try it become seizure free, or almost seizure free. And over half who try it gain a 50% reduction in seizures. The remainder do not respond or are unable to tolerate the diet because of side effects.
Treatment: A Graded, Individualized Approach
Treatment decisions for adult AVMs are among the most nuanced in all of eurosurgery. Not every AVM requires immediate intervention, and the risks of treatment must always be weighed carefully against the risks of observation. Our team uses the Spetzler Martin Grading System — the standard clinical tool for assessing AVM surgical risk — to evaluate each patient’s case based on AVM size, location, and venous drainage pattern before any treatment recommendation is made.
Microsurgical Resection
Open surgical removal through a craniotomy remains the most definitive treatment, offering immediate cure when complete resection is achieved. Most appropriate for accessible, lower-grade AVMs — particularly those that have already bled. Our surgeons use intraoperative neurophysiological monitoring and image guided navigation throughout the procedure.
Stereotactic Radiosurgery
Focused radiation — delivered via systems such as Gamma Knife — gradually obliterates the AVM over two to three years without open surgery. Best suited for smaller, deep seated AVMs that carry high surgical risk. Radiosurgery does not provide immediate protection against hemorrhage
during the obliteration period, a consideration that factors into treatment timing discussions.
Endovascular Embolization
A catheter-based procedure used to selectively block blood vessels feeding the AVM, reducing its size and blood flow. Most commonly used as a preparatory step before surgery or radiosurgery rather than a standalone cure, though in select cases it can achieve significant AVM reduction.
Observation
For older adults, patients with small asymptomatic AVMs, or those with high-grade lesions where treatment risks outweigh benefits, careful monitoring with serial imaging may be the most appropriate path. Observation is an active, managed decision — not inaction.
Epilepsy Surgery Recovery Time
Can Surgery Cure Epileptic Seizures?
Epilepsy surgery is measured by the level of improvement in seizures and quality of life. Adult studies of epilepsy surgery have shown that seizures can be greatly reduced or totally controlled in some cases, and many can stop AEDs. Pediatric studies also report that the majority of infants and young children show favorable outcomes in seizure control, and can also stop AEDs after surgery.
Success Rate After Epilepsy Surgery
Expert AVM Care Across New Jersey
If you have been diagnosed with an AVM — or experienced a neurological event that may be AVM related — you need a neurosurgeon with the cerebrovascular expertise to interpret your imaging accurately and present you with every available option. Advanced Neurosurgery Associates provides that level of specialized care at four New Jersey locations in Rutherford, Jersey City, New Brunswick, and Morristown.
We treat both the condition and the person — taking the time to understand your priorities, answer your questions thoroughly, and build a plan around your life.
AVM Care Across New Jersey
An AVM diagnosis doesn’t have to be overwhelming. Contact Advanced Neurosurgery. Associates today for expert evaluation and a clear path forward.