Brain arteriovenous malformation (AVM) surgery: Overview
A brain arteriovenous malformation repair is a type of surgery. It removes a group of tangled blood vessels. This is called an arteriovenous malformation or AVM. The blood vessels in an AVM may get weak and leak or burst. This can make the tissue near it bleed.
An AVM can happen in many areas of the body. But it is often found in the brain. An AVM in the brain may cause seizures.
Before the surgery, you will go to the hospital to have an angiogram of your head. This is a type of X-ray test. It uses a special dye and camera to take pictures of blood flow in the blood vessels of your head. At this time, you may also have a procedure called AVM embolization. It sends tiny particles or a glue-like liquid into the AVM to block blood flow to it. This can make it easier for the doctor to remove the AVM during your surgery.
To do the surgery, the doctor will make a cut in your scalp. This cut is called an incision. Then the doctor may take out a part of your skull bone to be able to reach your brain. The doctor stops blood flow to the AVM and then removes it.
After the AVM is removed, the doctor may use small metal plates and clamps to put back the piece of your skull. Then the doctor closes the incision with stitches or staples.
You may stay in the hospital for a few days.
After brain arteriovenous malformation repair: When to call
Call 911 anytime you think you may need emergency care. For example, call if:
- You passed out (lost consciousness).
- You have sudden chest pain and shortness of breath, or you cough up blood.
- You have severe trouble breathing.
- You have symptoms of a stroke. These may include:
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is different from past headaches.
- Your body is jerking or shaking.
- You feel very sleepy.
Call your doctor now or seek immediate medical care if:
- You fall and hit your head.
- You have a fever with a stiff neck or a severe headache.
- Your have new or worse headaches.
- You are sick to your stomach or cannot keep fluids down.
- You have pain that does not get better after you take pain medicine.
- You have loose stitches, or your incision comes open.
- Bright red blood has soaked through the bandage over your incision.
- You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the incision.
- Pus draining from the incision.
- Swollen lymph nodes in your neck, armpits, or groin.
- A fever.
- Your incision leaks fluid, or fluid builds up under your scalp near the incision.
Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.
How do you prepare for brain arteriovenous malformation (AVM) surgery?
Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.
Preparing for surgery
- Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
- Understand exactly what surgery is planned, along with the risks, benefits, and other options.
- Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
- If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
- Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
How can you care for yourself after brain arteriovenous malformation (AVM) surgery?
Activity
- Rest when you feel tired. You may feel sleepy more often than you did before the surgery. Plan to take a nap every day. Getting enough sleep will help you recover.
- When you sit up after lying down, bring your head up slowly. This can prevent headaches or dizziness.
- Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
- Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for 2 to 4 weeks or until your doctor says it is okay.
- For 3 weeks, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
- Do not play any rough or contact sports until your doctor says it is okay.
- You can wash your hair 2 to 3 days after your surgery. But do not soak your head or swim for 2 to 3 weeks.
- You will probably need to take at least 6 weeks off from work. It depends on the type of work you do and how you feel.
Diet
- You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
- Follow your doctor's instructions about drinking fluids.
- You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
Medicines
- Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
- If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
- You may get medicines to prevent seizures and brain swelling. Take them exactly as directed by your doctor.
- Be safe with medicines. Take pain medicines exactly as directed.
- If the doctor gave you a prescription medicine for pain, take it as prescribed.
- If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
- If you think your pain medicine is making you sick to your stomach:
- Take your medicine after meals (unless your doctor has told you not to).
- Ask your doctor for a different pain medicine.
- If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
Incision care
- If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
- Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage. Change the bandage every day.
- Keep the area clean and dry.
Ice and elevation
- For the first 1 to 2 days, you can use ice to reduce pain, swelling, and itching. Put ice or a cold pack on your head for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
- Try not to lie flat when you rest or sleep. You can use a wedge pillow, or put a rolled towel or foam padding under your pillow.
Rehabilitation
- Your doctor may recommend that you work with a speech therapist or occupational therapist if the surgery affected your speech or your ability to do your daily activities.
Other instructions
- Do not use an enema or laxative unless your doctor says it is okay.
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