Treatment Arteriovenous malformation (AVM) abroad

Av-malformation of brain is an abnormal tangle of abnormal blood vessels that connect the arteries and veins in the area of the brain. To understand better what is the malformation of arteries and veins, the person needs to know their function in the brain. Overall, the arteries are responsible for the transportation of blood from the heart to the brain Moreover, this blood must be rich in oxygen, so the arteries contain special oxygen-cells. The blood which does not have an oxygen is carried to the lungs and back to the heart, because the brain can naturally accept only oxygen-cells blood. During the av-malformation of the brain this process experiences the disruption. It means that blood with oxygen and blood without it mix and create the chaos. The arteriovenous malformation, which is a full name for av-malformation. may develop in any part of the body, but most often if affects the brain and the spine. The brain av-malformation happens very rarely and less than 1% of the population experience it.  

The cause of brain malformation is still unknown. People are usually born with it, but sometimes they can accumulate the disease during their lifetime. It is not transmitted genetically, as it was proved that the disease appears absolutely randomly. Brain malformation is usually diagnosed during the brain scan or tomography.

Brain malformation symptoms include:

  1. hemorrhage of the brain vessels
  2. rupture of certain brain tissues
  3. seizures similiar to epilepsy
  4. constant pain in one specific area of the head
  5. some muscles become weak and can not function as before
  6. the body becomes numb
  7. the patient may lose vision partially or fully
  8. difficulty during speaking: the patient mumbles, stutters and can not pronounce certain sounds. He can also become speechless during the stressful situations or when the patient is elated or anxious about something.
  9. the coordination becomes unsteady and
  10. the person may stop understand others and lose the emotional health

Other complications of av-malformation are that the brain does not have enough oxygen to function properly. This means that the person feels dizziness all the time, he is sleepy even after a good night rest and he is also yawning non-stop.

First symptoms of av-malformation may appear at the age of 11-12. Some patients begin to feel the rupture of brain tissues only when they are 40 or 50. In the long run the brain malformation may cause the serious damage of brain tissues, which can even result in death. The symptoms gradually build up and become more and more severe over the course of several years. If the av-malformation appeared in the middle age when the person is 30-35, the symptoms develop not so fast and there is certain stability in the health condition of the patient. Sometimes the brain malformation shows itself during the pregnancy, when the woman suddenly experiences the hemorrhage of the brain tissues and severe headaches. Nevertheless, the brain malformation is more common for men that for women.

The most dangerous type of brain malformations is called the Galen defect. This defect is inborn and it can appear right after the birth or during the first months of baby`s life. If the person has the Galen effect, the blood vessels start to accumulate in his rain to the point when the head swells enormously. The swelling is especially seen on the scalp and near the neck. Because of this swelling the brain experiences compression and the fluid, which was earlier directed in specific areas of the brain, starts to freely flow in any part of the hemisphere. The Galen defect may also cause various heart diseases, because the blood does not return properly back to the heart.

The diagnosis of av-malformation

As it was mentioned above the most common diagnose method is the brain scan. To understand better the nature of the disease, the doctors may also use the cerebral arteriography during which the location of arteries is revealed. The magnetic imaging may also be a solution. It helps to obtain the microscopic image of the brain with its smallest deviations from the norm. It can also detect if there`s an excessive amount of blood in the brain.

Treatment of AV

The most dangerous complication of brain malformation is the brain hemorrhage, that`s why the treatment of malformation mostly aims to prevent or stop the bleeding and  the seizures. Medicine in this case may only alleviate the pain and reduce the number of headaches. To cure the brain malformation, the patient needs to undergo the surgery. It includes:

Resection of AVM. During the resection the surgeon makes an incision and opens a scalp. After that he identifies the exact location of the damaged brain tissue and removes the malformation around this. To complete the operation, he seals the scalp back. If the malformation is located too deep, the neurosurgeon simply can not reach it. If that`s the case the doctors advise to choose other treatment option.  

Embolization of the arteries. This is a more difficult procedure than the resection of the AVM. During the embolization the doctor makes an incision in the leg muscle and put a tube into the artery. The tube is also called a catheter. The doctor can track the catheter through the X-Ray which shows its exact location. The embolization may reduce the size of the malformation and prevent further bleeding.

Radiosurgery. During the radiosurgery the doctors use irradiation to destroy the malformation. In this case the irradiation scares the affected cells, so that they simply scatter. If the malformation is too big, it is impossible to make the cells vanish. The biggest drawback of the radiosurgery is that the cells, which formed the malformation before, may gather again and create even a bigger problem. Moreover, the irradiation has a long line of serious side effects: the immune system of the person weakens, he loses his hair, his skin worsens and general health condition deteriorates. That`s why it is more preferable to undergo the surgery. Recent advances in medicine allow the doctors to almost diminish the malformation with the microsurgery, which can reach the most distant cells and prevent their future growth.

After the treatment was finished it is essential for all the patients to undergo the regular check-ups and to maintain the healthy lifestyle, For instance, the patients are advised to have the physical therapy and to avoid any stressful situation in future, which can cause the hemorrhage of the brain. The patients also need to regularly control their blood pressure. If it is high, they are prescribed with the drugs that can normalize the blood flow and prevent the patient from having the hypertension. The main precaution measure is the control after the blood flow in the body of the patient.

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RWTH University Hospital Aachen

Gamma Knife has been installed since July 1998 in the University Hospital Aachen and it is operated in cooperation with the Department of Neurosurgery and the Department of Radiotherapy. Since then, around 1,800 patients with various diseases (statistics of 01.

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Alfried Krupp Hospital in Essen-Ruettenscheid

The Department of Neurosurgery at the Alfried Krupp Hospital in Essen focuses on the following tasks and areas: microsurgery, vascular brain surgery, brain tumors, skull base surgery, spinal column surgery, traumatic brain injury, peripheral nerves, pain therapy, radiosurgery.

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