Start here if you’re new to brain AVMs. We break down the first steps in understanding what you’re really looking at — and how to begin seeing things others might miss.

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Script:

Hey everyone, welcome. So today’s talk is for you if you’re just starting out with brain AVMs. If you’re a complete beginner, this is where you need to be.

First of all, AVMs — they’re complicated. It honestly takes a lot of time and patience to really understand their angioarchitecture and how to treat them safely.

And in the beginning, I really urge you to sit down and study all the imaging. Take a good hard look at the MRI. Look at any previous angiograms, CT angios, MR angios — anything you can find. Everything helps. The more you see, the more you understand.

The key to treating AVMs — the real key — is understanding.

If you understand the anatomy, if you know exactly which arteries are feeding the AVM, how many veins are draining it, where it sits in the brain — then you’re already halfway there.

And the location matters so much. Is it near the speech center? Next to the brainstem? Hugging the thalamus? Each of these comes with its own challenges. Because traditional endovascular treatment through the arteries can sometimes hurt the surrounding brain if you’re not careful.

So if you’re treating an AVM near the speech area, you have to talk to the patient and family beforehand. Let them know — after the procedure, there could be some speech problems, at least for a while.

Now, when you’re trying to understand an AVM — really get it — you can’t just look at one image alone. You have to correlate everything.

Here’s how you do it. Open the coronal MRI next to the AP angiogram. Put them side by side. They’re basically the same plane — both showing you a front-to-back view.

Then do the same with the sagittal MRI and the lateral angiogram. Again, side by side — both working in the same right-to-left plane.

And here’s the trick: scroll through the slides together. Slide by slide. Scroll through the MRI and at the same time, scroll through the angiogram.

You’ll start noticing — this vessel I’m seeing on MRI matches that shadow on the angio. That draining vein in the MRI? It’s the same one I’m seeing emptying on the angio.

At first, it’s confusing. But if you stick with it, it clicks. You start to see the AVM in 3D inside your head.

Now, about the draining veins. They’re tricky. You don’t always spot them right away.

Usually, each lobule of the AVM nidus drains into small primary veins. And these then join up to form the bigger draining vein or veins.

Sometimes the main draining vein splits into branches. Sometimes it stays as one straight vein, draining either to the superficial or deep venous system.

Here’s a mental image that helps: think of the AVM as a tree.

The nidus is the leaves. The veins are the branches and the trunk. If you’re lost, think: where’s the center of the tree? That’s usually where the veins start to exit.

It’s a simple analogy, but it helps more than you think.

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Contact & Resources:

For questions or collaboration, feel free to reach out:

Email: dr.mostafafarid@med.asu.edu.eg

YouTube channel: youtube.com/drmostafafarid