Arteriovenous malformation
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AVM (arteriovenous malformation) is a congenital disease that manifests itself by the formation of pathological blood vessels plexus and arteriovenous anastomoses (pathological binding between the veins and arteries). If the disease is not treated, the AVM in the brain sooner or later leads to hemorrhage in 2/3 of the patients.
The Booking Health portal presents 51 German clinics specializing in AVM (arteriovenous malformation) treatment
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AVM (arteriovenous malformation) – Diagnostics
The following methods are used for the diagnostics of AVM:
- Electrophysiological diagnostics is not specific, but helps a doctor to suspect AVM. Rheoencephalography (determination of the electrical resistance in the various parts of the brain) and electroencephalography (determination of the bioelectric activity in the brain are also performed.
- Doppler ultrasound examination can detect blood flow changes in the certain areas of the brain. Transcranial doppler helps to detect "the shunting phenomenon" (mixing of the blood between the binded artery and vein).
- Computed tomography is an X-ray examination method that identifies the AVM from 2 cm. The method is also used to determine the localization of hemorrhage in case of arteriovenous malformations rupture.
- Cerebral angiography is the most informative but dangerous method of diagnostics. Therefore, it is performed only according to indications (in case of haemorrhage, after surgery, and also in case of suspected AVM, if the controversial results were received after the non-invasive examination). The contrast agent is injected into the blood vessels, then with the help of X-ray they are visualized.
Best clinics for the AVM (arteriovenous malformation) diagnostics in Germany:
AVM (arteriovenous malformation) – Treatment
AVM can be eliminated only surgically. However, surgical treatment is indicated only for patients with an increased risk of ischemic stroke or hemorrhage in the brain, or those who suffer from symptoms of this disease.
The surgery is indicated in the following cases:
- Presence of hemorrhages in the anamnesis
- AVM of the third or fourth stage
- AVM of the second stage with low risk of neurological disorders after surgery (localization in the “silent” brain areas or presence of AVM up to 4 cm in functionally active brain parts)
- AVM of the first stage if the patient wants to undergo surgery and risk of surgical complications is low.
While making a decision about the surgery, a patient should remember that 45% of AVMs eventually disrupt even if there are no symptoms of the disease.
The following surgical methods for the treatment of AVM are used:
Extirpation of AVM is a very complicated type of surgery that demands a highly qualified and experienced neurosurgeon and modern medical equipment. The purpose of the surgery is removal of the pathological vascular plexuses and restoring the normal blood flow. In most cases results of the operation depend on the doctor's skills and level of equipment at the hospital.
Endovascular occlusion of AVM is used more and more often as it has an obvious advantage: it doesn’t require craniotomy. It is used if there are high surgical risks, when AVM is large and located in functionally active parts of the brain.
In case of chemical occlusion thrombosing substances are injected into the blood vessels. Blood clots block the blood flow through the abnormal vascular plexuses.
Embolization with platinum coils has been used frequently in recent years. The coils are placed inside the vessel that leads to blood clots formation and blocking the lumen of the veins and arteries.
Gamma knife. Coagulation of the small and medium vessels is performed with the help of the directed radiosurgical influence. Gamma rays are directed into the desired area. They are focused at one spot. As a result of the vascular endothelium damage and blood clots formation, the blood flow through the veins and arteries of the AVM is completely or partially terminated. The main advantage of this method is non-invasive and painless treatment. The procedure does not require any surgical incision.
AVM coagulation by the directed proton beam is a similar, but more accurate, method of treatment (gamma knife has an error of 0.2-0.3 mm). This high-tech procedure is rarely performed in practice, because it requires an expensive equipment. This treatment method is carried out only in the best clinics of the developed countries.
Best clinics for the AVM (arteriovenous malformation) treatment in Germany:
Gamma Knife and Radiotherapy Center Krefeld
Arteriovenous malformation – Rehabilitation
The most modern rehabilitation programs are used in Germany. They are adapted individually for each patient, and are based on the disease stage, age, physical possibilities, and the results of treatment. Different specialists such as: therapists, neurologists, psychologists, rehabilitators, kinesiotherapists, physiotherapists are involved in the rehabilitation process.
The following methods of rehabilitation are used:
- Dosed physical activity
- Training on the simulators and in the pool
- Individual orthoses
- Physiotherapy
- Acupuncture
- Manual therapy
- Transcranial magnetic stimulation
- Natural factors of the nature (mud, thermal waters, etc.)
- Individual or group therapy with a psychologist
Rehabilitation may include medicamentous support. It is necessary to hold a consultation with the patient about the proper nutrition and the way of life which is important for him in the current situation.
Rehabilitation programs in Germany are designed for 2 weeks. If necessary, they can last much longer. In this country, the patient is provided with qualitative care, accommodation in comfortable rooms and individually selected meals.
Rehabilitation programs in Germany show one of the best results in the world. Most patients successfully restore their working capacity and excellent health there. They remain physically active, return to the full social and family life.
Best clinics for neurological rehabilitation in Germany:
Author:
The article was edited by medical expert, board certified Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
Centers for Disease Control and Prevention
The cost of services includes
Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.
The program includes the following:
- Issuing of an invitation for getting a visa for treatment as quick as possible
- Fixing an appointment at a time convenient for you
- Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
- Arranging transfer from the airport to the hospital and back to the airport
- Provision of interpreting services and services of a personal medical coordinator
- If necessary, assistance in the organization of further surgical treatment
- Provision of a medical insurance against treatment complications covering up to 200,000 euro
- Preparation and translation of medical records and recommendations from the hospital
- Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc