An Arterio-Venous Malformations (AVM) is a tangle of abnormal and poorly formed blood vessels (arteries and veins), with an innate propensity to bleed. An AVM can occur anywhere in the body, but brain and spinal AVMs present substantial risks when they bleed. Because the brain and its blood vessels are formed together during embryological development, abnormal blood vessel formation is often associated with abnormal brain tissue. A person with an AVM may experience no symptoms. AVMs tend to be discovered only incidentally, usually either at autopsy or during treatment for an unrelated disorder. AVMs can irritate the surrounding brain and cause seizures or headaches. The most common symptom is brain haemorrhage. The three types of treatment available include direct removal using microsurgical techniques, stereotactic radiosurgery, and embolization.
AVMs are identified by the scan of the brain by magnetic resonance imaging (MRI). Further information is obtained by performing a cerebral angiography to understand its size, shape, exact location and pattern. It is then graded and accordingly the treatment option is decided. The main factor of determining the treatment option is the age of the patient, medical history, past history of AVM and the probability of future occurrence. Surgery is the most common approach. The surgical procedure is performed neurosurgeons and their teams.
The patient needs to be hospitalised prior to the day of surgery and all the necessary blood tests, ECG etc. are performed to ensure the stable physiological conditions. Overnight fasting is necessary. The surgery is performed under general anaesthesia. Opening of the skull ((craniotomy) is performed and the AVM is carefully cut out from the surrounding brain. This is an intricate surgery and can take several hours. The skull is stitched and patient is kept under observation in the Neurosurgical Intensive Care Unit. The normal hospital stay is around 1 week and a repeat angiogram is performed to ensure the AVM is completely removed. Patient needs to be rest and recover at home for at least 2 months.
Many patients undergoing microsurgery make an excellent and quick recovery after several days of hospitalisation.
The risks of serious complications are associated with this surgery. All this necessary information must be shared prior with the surgeon. Post-surgery, there are chances of stroke-like symptoms such as weakness in either of arms or limbs, numbness in fee and arms, tingling sensations, speech disturbances, visual problems or impaired vision. In worst cases there could be paralysis. Seizures, fainting episodes are also few of the complications of this surgery. As surgery is the best option, it is recommended to perform such surgeries by highly skilled neurosurgeons and the team at a specialised institute.
Who is affected by AVM?
AVMs of the brain and spine are congenital (present at birth) and relatively rare. They affect both men and women at about the same rate. They can occur at all ages, but most often cause symptoms between 20 and 40 years of age.
What treatments are available?
Surgery, endovascular therapy, and radiosurgery can be used alone or in combination to treat an AVM. Endovascular embolisation is often performed before surgery to reduce the AVM size and risk of operative bleeding. Radiosurgery or embolisation may be used after surgery to treat any remaining portions of the AVM.
How is a diagnosis made?
Symptoms, current and previous medical problems, current medications, family history, and physical examination are used for the diagnosis. Diagnostic tests are used to help determine the AVM's location, size, type, and involvement with other structures.
Can AVM be completed cured by the surgery?
Yes; The chances of complete cure following surgery is high as AVMs are completely removed and the chance of recurrence is negligible.
What are the advantages of this surgery?
Due to the complete removal of the AVM, protection against haemorrhage (bleeding) is prevented. Once this procedure is performed no other treatment shall be required in future in most of the cases.
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