Central Nervous System Vascular Malformations

Central nervous system (CNS) vascular malformations are rare, occurring so seldomly that most neurologists never see a case in their entire careers. This means a patient may not know where to turn when diagnosed. Our team of board-certified neurologists, neurosurgeons, neuropathologists and interventional radiologists at The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health are specialists in the diagnosis and treatment of all types of vascular malformations, including CNS vascular malformations. We utilize this multidisciplinary team approach and minimally invasive image-guided treatments to effectively minimize patients’ discomfort and address their symptoms.

Understanding the Vascular System

Think of your vascular system as the highways of your body, comprised of 3 types of blood vessels: arteries, veins, and capillaries. While the veins carry blood back to the heart for reoxygenation, the arteries carry oxygen-rich blood from the heart to every part of the body. The capillaries connect the arteries and veins. Any dysfunction of the vascular system can cause severe pain and disability, even death.

Vascular diseases are those which affect the blood vessels (arteries, veins, or capillaries). Vascular malformations in the brain or spinal cord may lead to headaches, seizures, or strokes. Diagnosis is usually made through a doctor’s exam, and further examination requires imaging tests to provide images of the affected blood vessels and to determine which type of CNS vascular malformation the patient has.

The main types of CNS vascular malformations, and their symptoms, include:

  • Capillary malformations: This vascular abnormality causes pink, red, or purple splotches on the skin, and can occur anywhere on the skin of newborns. It occurs because the skin has extra blood vessels close to the surface. When this type of malformation occurs near the forehead or upper face, it can put the patient at risk of eye and brain problems, which means the patient will need to be seen by a pediatric neurologist and an ophthalmologist.

  • Cavernous malformations (CM): This involves clusters of abnormal blood vessels in the brain and/or spinal cord. It can cause seizures, vision problems, difficulty balancing, and memory/attention problems. Surgery is usually the first-line treatment for seizure control, particularly if the CM is located in a low-risk, easily accessible part of the brain.

  • Developmental venous anomaly (DVA): This congenital malformation of the veins of the brain, also called a venous malformation or venous angioma, is one of the most common cerebral vascular malformations. Serious symptoms are unlikely to occur, but there may be related conditions that can cause serious symptoms. There is a risk of the patient having a hemorrhagic stroke caused by a blood vessel bleeding in the brain.

  • Arteriovenous malformations (AVM): These affect the arteries and veins of the brain and/or spine, but not the capillaries. The blood vessels become enlarged, twisted, and tangled. Symptoms may include seizures, severe headaches, and weakness or numbness on one side of the body. Strokes are a serious risk of brain AVMs.

  • Arteriovenous fistulas (AVF): These involve abnormal connections between the arteries and the covering of the brain and/or spinal cord (the dura) and a draining vein.

CNS Vascular Malformations Treatment

Treatment for a CNS vascular malformation may include surgery, depending on the difficulty of completely removing the malformation. If the malformation cannot be completely removed, it will recur. An interventional radiologist may provide nonsurgical treatment to stop blood or lymph flow to the vascular malformation by embolization. This is done by using a tiny plastic tube no larger than the point of a pencil into the feeding artery of the malformation. The physician is able to complete this procedure without incisions or stitches, and only mild sedation.

Treatment by embolization may not always be 100% effective, but patients often notice an immediate improvement in their symptoms due to the increase in oxygen levels to the brain. However, CNS vascular malformations are difficult to treat, because they can pull in new artery feeders. Embolization can be effective in blocking abnormal artery feeders, but usually a series of treatments is needed to block all the abnormal feeders.

Request an appointment online now or call 833-656-3876.