AVM Surgery without embolization

Hi All,

I was curious how many of you have had your avms removed without having embolization first? Seems like some doctors recommend embolizations prior to surgery so that there is less risk of bleeding during the surgery and others prefer to not do embolization and just clip the feeders as they go.

Any of you get an avm removed without first getting an embo? Is there a higher risk for errors?

Any feedback would be appreciated.



I don’t think it’s about “errors” I think the idea of embolisation pre resection is to reduce bleeding, as you say. If your doc is proposing to go straight in, it may be that your AVM isn’t so complex and he or she is comfortable with operating without needing to put you through an embolisation beforehand. I would have thought it would be the more complex AVMs with lots of feeders that deserve embo prior to surgery, or it may just be a preference of the surgeon.

Worth discussing with the surgeon whether embolisation prior to surgery is a good idea and see why they dismiss it (if they do).

Hope these thoughts help,


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What I have learned from all of this is that, you’re in the hands of your neurosurgeons(good, sorta)

So, they do whatever they deem necessary case by case basis - every case is different, every patient is different - every surgeon is different


I agree with Mike_az_21. In my case my Neurointerventional Radiologist tried to embolize my spinal AVM but could not complete the procedure due to complications with spinal cord. He referred me to proper Neurosurgeon to address the issue.

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I had a bleed 1 month after finding out I even had an AVM and it was removed with surgery… I had no other procedures prior and had to put my trust into the Neurosurgeon who operated on me… I hope this helps you… God bless!


Hey there, I second or third the recommendations to follow drs orders. But a second opinion is always an option. I actually got a second opinion and they found another AVM! I went with Duke and was not disappointed! Neurology Patient Appointments | Duke Neurology

Barrow is another good one I’ve heard but have not gone:

Blessings as you continue!

I have seen three neurosurgeons and also an opinion from Barrow. Barrow and another neurosurgeon suggested embo followed by resection. Another said definitely don’t get surgery and only do gamma and another said suggested surgery without embo. I know this is common to have various opinions from various surgeons. I do feel like it is tough to make a decision as it isn’t something that I know too much about in regards to risks and complexity of a surgery with and without embo. Every doctors skillset is different too I believe and they have preferences to methods. This is why I ask the question.

Wow, just wow!

To get such different opinions from neurosurgeons

My opinion & experience is that BMI is as close to the best you can get in this field

Of course, this just my opinion & outcomes vary by the slightest change in anything

GL, my prayers are with you! - this shit is the real deal & is as tough as it gets


I think we all understand the difficulty here. I think the final piece of the puzzle is which of the doctors did you get most confidence from? Because there may be no “right” answer and so it comes to which approach and which surgeon you’re happiest with.

And, honestly, we all need that test to be passed. We all have to be happy with the person we’re letting inside our head and what they’re planning to do.

The guy I “chose” (actually, was given) was very mechanical, very focussed on the task and much less good at the patient conversation (at least, so I thought when I first met him). But I decided that it was the slightly autistic-leaning engineer who just knew what he was doing that I wanted to trust with my brain. I don’t care if the guy can tell a good story or not, or put on a listening face. I went with the mechanic and that was how I saw it. So try to make your mind up from the folk you’ve seen. Of all the approaches, which one gives you the best confidence in their plan?

That feels like the final part of the jigsaw to me.

I’d also say that my guy, in theatre, was completely different. Very animated, very talkable. I think it was the consulting room that he didn’t really relate well to. As a team, in theatre, they were like a well maintained machine. Absolutely spot on.

Good luck!


Hi Mike, like Richard says, worth discussing with your surgeon and interventional/neuro radiologist their reasons behind their approach. Important that they have experience and expertise in removing avms as my doctors had for my 2008 facial avm resection which was without prior embolization. I also like to get second opinions from other experienced and expert doctors in avm resection. Best wishes, Soteris

When correctly diagnosedd 2011 I had no insurance. I was referred to IR which suggested 3-5 embos followed by crani. However, because of my misdiagnosis in 1975 the surgeon convinced me that surgery was higher risk than bleed. Til I bled in 2018. New surgeon said just crani because my avm was small and shallow. It couldn’t have gone better. I think a 2nd and 3rd opinion is a good idea and I would ask each why they recommend their procedure as opposed to the others. I didn’t like the added risks with all the embos so I put trust in God and my surgeon.

Hi Mike, I had a craniotomy without embolization. And then a second craniotomy three months later! To my understanding this had nothing to do with not having embolization. My AVM was in the occipital-parietal junction and was close to the surface, small, and most importantly, had ruptured. The first craniotomy took place just 8 days after my hemorrhage and was as much about cleaning up the bleed as it was about resectioning the AVM. Because of the degree that I bled and the small size of my AVM, it was virtually impossible to catch the entire AVM the first time. Post-op imaging showed residual bits of the AVM, so, I had a follow up surgery (without embolization). While I haven’t done a ton of reading/research about the risk for errors, my basic understanding is that with micro-AVMs like mine, that are quite superficial, a really skilled neurosurgeon would prefer to just operate vs. taking additional risk on an embolization. FULL DISCLOSURE: I do not want to provide medical advice, I’m just sharing my experience. I’m happy to discuss the details of my surgeries, aftercare, recovery etc. if you’re going that route. Most importantly, talk with your neurosurgeon and like others have said seek second or third opinions. There are some really great surgeons out there who are skilled and confident and successfully perform AVM resections with regularity.


I would agree Mike - Barrows is by far, the best. I’ve worked in healthcare for 40+ years and I’m hard to impress. But the care and the staff were amazing.


No embolization. I had a bleed in October and they waiting to operate in June of the following year. Regular craniotomy. Haven’t been able to get off the post surgery seizure meds though.

Hi Mike,

I just had my spinal AVM successfully resected at Barrow by Dr Lawton in July following being told by multiple other neurosurgeons that it was too dangerous to do so.

The plan from Barrow was that I have the pre-op embolisation two days before the actual resection surgery to reduce the risk of bleeding in surgery. When I had my angiogram they did not end up embolizing due to the location of my AVM to the main feeders and other vital blood vessels. This obviously worried me as I then assumed my risks for surgery would increase. Dr Lawton was incredible at talking me through everything and giving me the reassurance I needed following this news. Two days later my AVM was completely removed! I am on my way to making a full recovery with just some sensory deficits taking a bit longer to resolve.

Everyone’s AVM is so different that I guess they have to make recommendations on a case by case basis. What I would say is that I can not fault Barrow at all with the care that they provided to me while I was there! They definitely know their stuff!



My daughter was treated by dr Spetzler, and she did not have embolization done prior to the surgery- even though the other drs that we consulted with recommended it.

I am so happy that your Dr. Lawton was able to remove your AVM.