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EDWARD Hospital and Health Services


Arteriovenous Malformations (AVM)

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At the Edward Neurosciences Institute, patients with arteriovenous malformations in the brain are evaluated by a team of specialists, including a vascular neurologist, neurointerventional surgeon and neurosurgeon. They review the results of each patient's CT and MR scans and other tests to determine the best course of treatment.

What is an Arteriovenous Malformation?

Arteriovenous Malformations (AVMs) are congenital blood vessel abnormalities found in the brain as well as elsewhere in the body. Composed of a complex tangle of arteries and veins, AVMs wreak havoc on the normally smooth operation of the human circulatory system with bleeding in the brain being a major cause for concern. AVMs account for two percent of all strokes and require prompt medical attention.

In healthy individuals, the heart pumps oxygenated and nutrient-rich blood to vital organs such as the brain. Moving at relatively high speed and pressure, blood leaving the heart travels throughout the body through a series of arteries from large to small. As blood flow reaches smaller and smaller arteries, it slows its pace until eventually it has transported its precious life-sustaining cargo to the capillaries. Among the tiniest vessels in the body, capillaries nourish brain tissue with oxygenated blood. At the same time, a carbon dioxide exchange takes place. From the capillaries, the veins carry non-oxygenated blood and other waste materials back to the heart and lungs. Blood flowing through veins, rather than via arterial routes, makes the return trip to the heart at a slower pace and with decreased pressure. It is at this point, that AVMs become a problem.

AVMs "short circuit" the system by interfering with the capillary mesh that usually exists between arteries and veins. This condition allows blood to return to the veins faster and with more pressure than they are designed to handle. Without this intermediary zone of give and take, the thin walls of the veins may expand and adversely affect adjacent areas of normal brain tissue causing weakness, numbness, loss of vision or seizures. Rupture of the supplying arteries, AVM, or the enlarged veins result in bleeding.

AVMs in the brain occur in less than 1% of people. Patients with AVMs, primarily considered to be congenital and not inherited, often are unaware of this condition until a diagnosis is made at the time of a seizure or an intracranial hemorrhage.

What are the Symptoms of an Arteriovenous Malformation?

In about half of patients with AVMs, the first symptoms are those of a stroke caused by bleeding into the brain. Symptoms of an AVM that has not bled include:

  • Seizures of all types and severity
  • Headaches
  • Confusion
  • Ear noise/buzzing
  • Problems walking
  • Blurred, decreased or double vision
  • Dizziness
  • Muscle weakness in any part of the body or face
  • Numbness in any part of the body

About 10% of cases in which excess bleeding (hemorrhage) is the first symptom result in death. Some patients may have permanent seizures and brain and nervous system problems. AVMs that do not cause symptoms by the time people reach their late 40s or early 50s are more likely to remain stable and rarely cause symptoms.

How Edward Diagnoses Arteriovenous Malformations

An Edward Neurosciences Institute Neurointerventional Team uses state-of-the-art CT (computed tomography) and MR (magnetic resonance) imaging to assess patients complaining of AVM symptoms such as seizure, headaches or stroke-like episodes. A cerebral angiogram or arteriogram will normally follow the confirmation of an AVM to identify the vessels creating the malformation.

Cerebral Angiogram:

  • Often scheduled as an outpatient procedure.
  • Performed in the Neurointerventional Lab.
  • Contrast (dye) is injected into the vessels in the brain allowing the Neurointerventionalist to visualize the AVM.
  • Following the cerebral angiogram, nurses in the recovery area will do frequent vital signs and check the groin area where the catheter was inserted.
  • Once the puncture site is stable (approximately 4-6 hours), the patient is discharged home.

Following the angiogram or arteriogram, a number of factors, from patient history to AVM size and location within the brain, determine the best course of action.

How Edward Treats Arteriovenous Malformations

A multi-specialty approach guarantees the most comprehensive treatment plan for AVMs. At the Edward Neurosciences Institute, neurosurgeons, neurointerventionalists and neurologists collaborate and coordinate all of these treatment options, which include embolization, open surgical removal, and/or radiation. Many times a combination of treatments is necessary for cure.

Procedures to Treat AVMs:

Endovascular Embolization: The Neurointerventional Team will inject onyx (a glue-like substance) into the vessels of the AVM to block the abnormal vessels.

  • Depending on the size of the AVM, the neurointerventionalist may need to perform this procedure several times to successfully block the AVM.
  • Following the embolization procedure, patients are transported to the Neuro Intensive Care Unit (ICU) for 1-2 days of close monitoring.
  • Nurses in the Neuro ICU will perform neuro assessments, check vital signs and administer medications and treatments necessary to promote recovery.
  • Once the AVM is successfully embolized, some AVMs are surgically removed or radiated to reduce size.

Neurosurgery: The neurosurgeon will schedule an elective craniotomy for surgical removal of the embolized AVM. With the blood vessels comprising the AVM blocked, surgical removal is safer because the risk of intracranial hemorrhage is reduced.

  • Following craniotomy for removal of the AVM, the patient is transported to the Neuro ICU for close monitoring and comprehensive care. The typical hospital length of stay is 7-12 days.

Recovery

Following treatment for an AVM, physical therapy, occupational therapy, speech therapy and swallowing therapy begin in the hospital. The goal of treatment is to help the patient recover as much function as possible. Recovery time is different for each person. Problems moving, thinking and talking often improve in the weeks to months after treatment.

Patient story: James Fijolek
PATIENT STORY: JAMES FIJOLEK

AVM recovery can be a lengthy process requiring complex care in the Neuro Intensive Care Unit. Dr. Mohammad Sajed, Medical Director of Edward Hospital's Neuro ICU, is a neurocritical care physician who's also board certified in vascular stroke neurology. Under his direction, critically ill neurological patients receive the latest in medical management, including frequent neurological assessments that can detect subtle changes in neurological function and potential for complications.

Patients require integrated care from the Edward Neurosciences Institute's team of neurologists, neurointerventional surgeons, neurosurgeons, skilled critical care nurses and rehabilitation therapists to maximize their functional recovery.

Read Visit www.edward.org/neuro for more information on the Edward Neurosciences Institute and click here to read a story of a patient recently diagnosed at treated for AVM at Edward.




 

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