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Arteriovenous Malformation
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Arteriovenous malformations (AVMs) are abnormal collections of blood vessels that occur in the brain which shunt blood from a high pressure artery to a low pressure vein. This shunting bypasses the brain tissues without delivering oxygen and nutrients as intended. These tangles of thin-walled blood vessels are probably present at birth in affected individuals and constitute a lifelong risk of sudden death due to spontaneous bleeding into the brain. The risk of sudden death from an AVM can be avoided by effectively obliterating the flow of blood through the nidus. This can be accomplished by 3 separate means. First, embolization is a procedure where a plugging material is let loose in the feeding artery to "clog" the feeding vessels. While it is sometimes difficult to accurately guide the plugging material into the feeding artery (misguided attempts may result in a stroke), embolization is often used in conjunction with the second treatment for AVMs, microsurgery. A skilled neurosurgeon employs an operating microscope to dissect through the brain to the AVM nidus and clamp the feeding vessels, thereby obliterating the bloodflow through the AVM. The final established treatment for AVMs is Gamma Knife radiosurgery. Gamma Knife radiosurgery for AVMs is one of the oldest indications with more than 30 years of published experience. The high dose focal radiation directed toward the nidus effectively obliterates the blood flow slowly over time. The treatment effect is not immediate, as at least 6 months is required (sometimes up to 3 years) to see angiographic obliteration. Success rates for Gamma Knife radiosurgery range between 60 to 90 percent depending on the size of the lesion. [Keywords: arteriovenous malformations, AVM, embolization, microsurgery, Gamma Knife radiosurgery] |
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