Arteriovenous Malformation

BACKGROUND

Arteriovenous malformationa (AVMa) are clumps of malformed and non-functional blood vessels allowing the flow of blood from the arteries directlyto the veins, without delivering oxygen or nutrients to the brain.

There is no functioning brain tissue within these lesions.

Most patients are probably born with their AVMs, but they can grow and bleed over time. Other than rare genetic disorders, we are not aware of the cause of these lesions.

 

SYMPTOMS
If AVMs bleed, they can cause sudden severe headache (often worse when seeing bright lights or hearing loud noises), nausea, vomiting, double vision, stroke-like symptoms, seizures and occasionally rapid death.

Even without bleeding, AVMs can still cause seizures and headaches.

Finally, AVMs can be found by accident when imaging the brain for unrelated reasons.
DIAGNOSIS

If the patient has a symptom of an acute bleed, CT scan, which can show acute blood clearly, is usually used.

Angiogram, or CT-angiogram can show the target vessels most clearly.
Finally, brain MRI is helpful is understanding the relationship of the AVM to critical brain regions, allowing maximal brain protection while planning Cyberknife radiosurgery or surgery.

TREATMENT

RADIOSURGERY, (CYBERKNIFE), is an exellent option for the treatment of AVMs, regardless of size and location. It can take years for AVMs to resolve after radiosurgery, and until they resolve, risk of bleeding persists. This residual risk can be hedged by use of embolization before or after radiosurgery.

Radiosurgery offers many advantages, including more exact targeting, less damage of tissue traversed on the way to the lesion, no pain, no surgical risks, and no needed anesthesia.

There are many areas of the brain which are simply too important to operate on, and if the AVM is in or near any of these areas, radiosurgery is the only option.

SURGERY Surgery offers the advantage of immediate peace of mind knowing that the risk of bleeding has been minimized.

ENDOVASCULAR EMBOLIZATION usually used in preparation for surgery or radiosurgery, involves injecting glue like material, or little springs, into the AVM, by feeding them through the blood vessels form the legs.