Arno H. Fried, MD, FACS, FAANS
Pediatric & Adult Neurosurgeon
Arteriovenous Malformations (AVMs) in Adults
An arteriovenous malformation (AVM) is a rare condition that often has no symptoms for many years. Some people don’t know they have an AVM until they experience a seizure, a severe headache, or another neurological problem. In other cases, it is found during a brain scan performed for an unrelated reason.
An unexpected AVM diagnosis can be overwhelming, but understanding your condition is the first step toward making informed treatment decisions.
At Advanced Neurosurgery Associates, we provide expert evaluation and treatment for adults with AVMs at our four New Jersey locations: Rutherford, Jersey City, New Brunswick, and Morristown. Our team works with you to explain your diagnosis, discuss your treatment options, and develop a personalized care plan based on your needs.
What Is an Arteriovenous Malformation (AVM)?
An arteriovenous malformation (AVM) is an abnormal connection between arteries and veins. Normally, blood flows through tiny blood vessels called capillaries before reaching the veins. In an AVM, this step is skipped.
As a result, blood flows through the vessels at higher pressure. This can weaken the blood vessels over time and increase the risk of bleeding in the brain or spinal cord.
What Causes an AVM?
Most AVMs are present at birth and develop before a baby is born. However, many people do not have symptoms during childhood.
Symptoms often appear between the ages of 35 and 40. In some cases, an AVM is only discovered after it causes a health problem or during imaging for another condition.
Why Is Early Evaluation Important?
A brain AVM can increase the risk of a hemorrhagic (bleeding) stroke, especially in younger and middle-aged adults.
Early evaluation by an experienced neurosurgeons of new jersey can help:
- Assess the size and location of the AVM
- Estimate the risk of bleeding
- Determine whether treatment is needed
- Create a personalized treatment plan
Visual suggestion:
Include a diagram comparing normal blood flow with blood flow through an AVM to help patients understand how the condition affects the brain.
Meet Our Expert Team
Board Certified Expert
At ANA — Movement. Vitality. Medicine., we are committed to providing exceptional pain, vein, and wellness services that empower individuals to reclaim their health and well-being. With our team of Harvard-trained experts, we strive to deliver transformative outcomes that restore comfort, confidence, and quality of life. ANA stands for our mission to help every patient relieve discomfort, restore motion, and renew life.
Meleine Martínez-Sosa, MD, FAANS
Pediatric & Adult Neurosurgeon
Kevin D. Wojcik, DO
Complex Spine Neurosurgeon
How Common Is AVM in Adults?
Arteriovenous malformations (AVMs) can affect both men and women. They occur in people of all ethnic backgrounds.
Most AVMs never cause symptoms. However, when symptoms do appear, they can lead to serious neurological problems if left untreated.
Women should know that pregnancy increases blood volume and blood pressure. These changes may trigger symptoms in a previously undiagnosed AVM. If you have an AVM or develop new neurological symptoms during pregnancy, seek medical evaluation promptly.
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Symptoms in Adults
Arteriovenous malformation 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)
FMRI scans use the same basic technological principles as MRI scans, but whereas MRI scans image anatomical structure, FMRI images chart metabolic function. Thus, functional MRI (fMRI) provides a non-invasive means of obtaining a ‘road map’ for the function of the brain. It is used to localize sensory, motor or cognitive function in the brain via changes in blood flow and hemoglobin oxygenation. Important information is obtained by integrating the results of fMRI with EEG.
Magneto-Encephalography
Magneto-encephalography (MEG) is performed using a machine that consists of a variety of highly sensitive magnetic sensors. These magnets are positioned around the scalp in a helmet-shaped container called a Dewar. They are attached to the scalp to detect small magnetic changes that arise from normal and abnormal electrical brain activity. This technology is a valuable tool because it can be used to localize the source of epileptic activity and normal functional areas of the brain for surgical planning in patients with epilepsy.
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
Neuropsychology testing is an important part of evaluation for epilepsy surgery. Conducted by an expert neuropsychologist, it is a formal assessment of cognition such as language, memory, attention and problem-solving. The neuropsychologist is able to determine how various parts of the brain are related to each of these tasks. This testing should be able to distinguish frontal from temporal brain dysfunction. This evaluation is also compared pre- and post-surgery to asses the effects of the surgery.
Diagnosis
Diagnosing an arteriovenous malformation (AVM) starts with a detailed medical history and neurological examination. Your neurosurgeon will review your symptoms and recommend imaging tests to confirm the diagnosis.
Imaging Tests for AVM
Your evaluation may include:
- MRI (Magnetic Resonance Imaging): Shows the AVM’s size, location, and its relationship to nearby brain tissue.
- Cerebral Angiography (DSA): The most accurate test for diagnosing an AVM. It provides detailed images of blood flow and helps plan the best treatment.
- CT Angiography (CTA): Uses CT imaging and contrast dye to evaluate the AVM and surrounding blood vessels.
- MR Angiography (MRA): Creates detailed images of blood vessels without traditional angiography and provides additional information about the AVM.
Why Are These Tests Important?
These imaging studies help your neurosurgeon:
- Confirm the diagnosis
- Measure the size and location of the AVM
- Evaluate blood flow through the abnormal vessels
- Check for associated aneurysms
- Create a personalized treatment plan based on your condition
Visual suggestion: Add an infographic showing the diagnostic process: Neurological Exam → MRI → Cerebral Angiography (DSA) → CTA/MRA (if needed) → Personalized Treatment Plan.
Medication
For many people, medication is the first step in controlling epilepsy. Taking your medication exactly as prescribed gives you the best chance of reducing or preventing seizures.
Some patients become seizure-free with their first medication. Others may need a different medicine or a combination of medications to achieve better seizure control.
Your Treatment Plan May Include
- Anti-seizure medications based on your type of epilepsy
- Dose adjustments to improve seizure control
- A combination of medications if one medicine is not enough
- Regular follow-up appointments to monitor your progress
Monitoring Your Progress
Finding the right medication can take time. Your doctor will closely monitor your response to treatment and make changes if needed.
During follow-up care, you may have:
- Blood tests to check medication levels
- Evaluations for possible side effects
- Reviews of your seizure activity
- Medication adjustments to improve results
Our goal is to find the safest and most effective treatment plan to help you manage epilepsy and maintain your quality of life.
Diet
A ketogenic diet is a special meal plan that is high in fat and low in carbohydrates. Instead of using sugar for energy, the body burns fat. This change can help reduce seizures in some children with epilepsy.
The ketogenic diet is often recommended when medications do not fully control seizures. It is carefully planned and monitored by a healthcare team to make sure your child gets the right nutrition.
How Can the Ketogenic Diet Help?
Many children see fewer seizures after starting the diet.
Possible benefits include:
- Fewer seizures
- Better seizure control
- Improved quality of life
- Less need for additional medications in some cases
Does It Work for Everyone?
The results are different for every child.
- About 10–30% of children become seizure-free or have very few seizures.
- More than 50% have at least a 50% reduction in seizures.
- Some children may not respond to the diet or may stop because of side effects.
Is the Ketogenic Diet Safe?
The ketogenic diet should only be started under medical supervision. Your child’s care team will monitor growth, nutrition, and overall health with regular follow-up visits.
Our epilepsy specialists will determine whether the ketogenic diet is the right treatment option and support your family throughout the process.
Treatment: A Graded, Individualized Approach
Treatment decisions for adult AVMs are among the most nuanced in all of neurosurgery. 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
Epilepsy surgery is a major neurosurgery. Some risk is associated with it and there is some mild discomfort afterward. The recovery period varies for each individual. The hospital stay also varies, depending on the specific procedure performed.
Most people can resume normal activities 2 to 8 weeks after epilepsy surgery.
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
It is critical for the patient and family to have realistic expectations of the results of the surgery. After surgery, some patients become completely seizure-free and some have no improvement at all.
Many people fall between these extremes, having fewer seizures or seizures that are less intense, or they require less medication. Most people who do become seizure-free after surgery must continue to take seizure medicines to prevent breakthrough seizures.
Although seizures may be greatly reduced or totally controlled following surgery, a number of patients report periods of depression during the adjustment period and it appears that the greatest benefit accrues to those whose seizures are completely controlled.
Expert AVM Care Across New Jersey
If you have been diagnosed with an arteriovenous malformation (AVM) or have symptoms that may be related to an AVM, getting the right care is important. An experienced neurosurgeon can review your imaging, explain your diagnosis, and discuss the best treatment options.
At Advanced Neurosurgery Associates, we provide specialized AVM care at our four New Jersey locations in Rutherford, Jersey City, New Brunswick, and Morristown.
We believe every patient deserves personalized care. Our team takes the time to answer your questions, explain your treatment options in clear language, and create a care plan that fits your needs and goals.
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.
Frequently Asked Questions
What are the common arteriovenous malformation symptoms?
Common arteriovenous malformation symptoms may include headaches, seizures, dizziness, muscle weakness, numbness, vision problems, and difficulty speaking. Symptoms vary depending on the AVM’s location and size.
When should I seek treatment for an arteriovenous malformation?
You should seek arteriovenous malformation treatment if you experience severe headaches, seizures, bleeding, or neurological symptoms. Early diagnosis and treatment can help reduce the risk of complications.
What treatment options are available for arteriovenous malformation?
Arteriovenous malformation treatment options may include minimally invasive embolization, microsurgery, radiosurgery, or a combination of treatments depending on the condition and severity.
Where can I find arteriovenous malformation treatment in New Jersey?
Advanced Neurosurgery Associates provides specialized arteriovenous malformation treatment in New Jersey with advanced diagnostic imaging and personalized care plans.
Who are arteriovenous malformation specialists?
Arteriovenous malformation specialists are neurosurgeons and vascular experts trained to diagnose and treat AVMs using advanced surgical and minimally invasive techniques.
How do I choose the best arteriovenous malformation specialists in Rutherford, NJ?
Look for experienced arteriovenous malformation specialists in Rutherford, NJ who offer comprehensive neurological care, modern treatment options, and personalized patient support.
What makes Advanced Neurosurgery Associates a trusted provider for AVM treatment?
Is minimally invasive arteriovenous malformation treatment available in Rutherford, New Jersey?
Yes, minimally invasive arteriovenous malformation treatment in Rutherford, New Jersey, may include embolization and radiosurgery to help reduce recovery time and improve outcomes.
Can arteriovenous malformations be cured?
Some arteriovenous malformations can be completely treated or removed depending on their size and location. Your specialist will recommend the best treatment approach after evaluation.