How is facial arteriovenous malformation (AVM) treated?

A facial AVM is a tangle of abnormal blood vessels in the face. It causes visible changes to how the face looks. Facial AVM can cause blood vessels to grow too large, which can lead to:

• This means one side of your face may look different than the other side.
• Replacement of bones, muscles and organs in the face. This means a facial AVM may wear down bones or occupy muscles and organs in the face.
• Dislocation (movement) of normal structures in the face. This can cause changes in the way your face looks (also called disfigurement).
• Lump in the face

Our experienced team of specialists, including leaders in the treatment of facial AVM, treat many patients who have facial AVM each year. Our unique combination of cutting-edge technology, teamwork, technical skill and compassion brings high-quality care to our patients.

We understand treatment can be stressful for many patients and families. Our guiding principle is to put the patient and family first. Your doctors are available to you throughout your care – before, during and after the treatment period.

What is the treatment for facial AVM at Brigham and Women’s Hospital?

There are two treatment options for facial AVM at Brigham and Women’s Hospital:

1. Careful observation (also called watchful waiting): If you don’t have symptoms, facial AVM may be treated with careful observation instead of surgery. This means your doctor monitors your health closely and you get follow-up medical care as needed if you develop symptoms.
2. Surgery: If you feel pain or other symptoms, or if the facial AVM is growing in size, open surgery may be offered in addition to endovascular embolization. Open surgery is traditional surgery that uses larger incisions (cuts). Endovascular embolization is a minimally invasive treatment where abnormal tissues and blood vessels are treated from inside the vessel. A minimally invasive surgery is a procedure that limits the size and number of incisions. It’s less risky than open surgery. You may also have a shorter hospital stay and recover faster and with less pain. It’s the preferred treatment and standard of care over open surgery. Some patients with facial AVM may have open surgery or a combination of endovascular and open surgery. Open surgery can vary in recovery time and requires consultation with surgeons.

What is endovascular surgery for facial AVM?

The standard treatment for facial AVM is endovascular surgery to close abnormal vessels. During the procedure, a surgeon inserts a tiny needle through the skin directly over the face or accesses the blood vessels of the face via the vessels of the groin or wrist. A catheter-based angiography is next used to make X-ray pictures inside the blood vessel. With this approach, the surgeon inserts a tiny, flexible tube called a catheter into the blood vessel and injects a special dye into the tube. The dye helps make images that show the surgeon any problems in the blood vessel. Our surgeons may use liquid embolic agents (glue or plugging devices) to help stop blood flow in the abnormal vessels. This process is called embolization.

Through this approach, many patients return home the same day of their surgery or the following day. Initial treatment rarely fully cures the facial AVM because it’s a complex condition. Patients usually need multiple treatments. But over time, these treatments help a patient manage symptoms of pain or swelling and enable patients to have surgery for appearance. Patients with more complex cases benefit from a very multidisciplinary approach, which is when doctors from a variety of specialties work together to treat facial AVM.

Your team of neurosurgeons and interventional neuroradiologists may collaborate with other specialists from Brigham and Women’s Hospital, including:

• Division of Plastic Surgery
• Division of Oral Medicine and Dentistry
• Division of Otolaryngology - Head and Neck Surgery

What can I do to help with my treatment?

It can be helpful for patients to keep excellent records. For example, track what imaging you’ve received, what symptoms you experience, and when the symptoms worsen or improve. By noting what worsens your symptoms, you can share valuable information with your doctor to help personalize your care.

How do I know if a facial AVM has ruptured?

When a facial AVM ruptures (bursts open), it can result in bleeding on the outside of the face. A rupture can be either a slow or sudden bleeding. This rupture is an emergency. Patients should compress the area of bleeding to lessen what they can and go to an emergency room for medical care

Contact the Center for Cerebrovascular Diseases

The Center for Cerebrovascular Diseases is home to a team of neurosurgeons and interventional neuroradiologists – including experts in the treatment of facial AVMs. Our team of specialists with deep experience in treating facial AVM include:

• Mohammad A. Aziz-Sultan, MD
• Karen Chen, MD

To schedule an appointment with a physician in the Center for Cerebrovascular Diseases, please contact our patient coordinator at: (617) 732-6600.

If you are a physician seeking to refer a patient to the Center for Cerebrovascular Diseases, please call (617) 732-6600 or you can access our physicians’ office phone numbers. To contact one of our physicians with a question, patient referral or second opinion, you may also email: BWHNeurosurgery@partners.org.