brain, spinal cord, and nerve disorders
Brain Arteriovenous Malformations (AVMs)
Treatment of Brain AVMs
Conservative management Microsurgery, radiosurgery, and/or endovascular surgery For cerebral arteriovenous malformations, the primary goal of treatment is to prevent Overview of Hemorrhagic Stroke . The risks of various treatments must be weighed against the risks of no treatment (which may include rupture, seizures, and, rarely disabling brain damage). Treatment options include Microsurgery to remove the aneurysm Stereotactic radiosurgery Endovascular embolization A combination of these procedures No procedure Doctors may recommend that no procedure be done if the risk of bleeding seems low or the risk of adverse effects from treatment seems high. In such cases, the aneurysm is regularly monitored for changes that could make rupture more likely. People who have had a ruptured AVM are usually treated with a procedure to eliminate the AVM. Microsurgeryinvolves removing a piece of the skull so doctors can see the AVM. Then, using a microscope, they locate and remove the AVM. Radiosurgeryis not really surgery because no incision is required. Radiation is focused precisely on the AVM and used to destroy it. Machines, such as a gamma knife and a linear accelerator, are used to produce the radiation. When a gamma knife is used, an imaging frame is attached to the person’s skull. The person lies on a sliding bed, and a large helmet with holes in it is placed over the frame. The head of the bed is then slid into a globe that contains radioactive cobalt. Radiation passes through the holes in the helmet and is aimed precisely at the AVM. A linear accelerator circles the head of the person, who lies on a sliding bed, and aims radiation precisely at the AVM from different angles. Forendovascular embolization,a thin, flexible tube (catheter) is guided to the AVM and a device (such as a coil) or material is used to prevent blood from flowing into the AVM. Endovascular embolization does not repair the AVM, but it reduces blood flow to the AVM and makes surgery, if needed, safer. It may be done before microsurgery or stereotactic radiosurgery. 