Aneurysms and Arteriovenous Malformations (AVMs)

What are aneurysms?

An aneurysm is an abnormal out-pouching on the side or wall of a blood vessel in the brain. It results from an interplay of weakness of the wall as well as high blood flow in the brain blood vessels. These vessels (known as arteries) are commonly seen in the base of the brain.

The problem with aneurysms are many. Due to their weakness, they are liable to rupture or break open. This initially leads to what is known as a warning bleed. This presents with severe headache (the worst ever experienced by the patient) coupled with vomiting, loss of consciousness or confusion and occasionally loss of function of a particular limb or limbs. In such situations, the patient should be immediately shifted to a neurosurgical center for intensive care and a probable surgery.

How can Aneurysms be diagnosed and treated?

Aneurysms are detected by angiograms (either direct or CT) where the defect in the vessel wall is visualized as well as its relation to the surrounding structures at the base of the brain, an incredibly complex and vital area of the central nervous system. Once detected, the neurosurgeon will probably discuss modalities of treatment for aneurysms, which include:

Microsurgical Clipping of the aneurysm: This involves surgery where highly skilled Neuro-Vascular Surgeons operate under an operative microscope and place a titanium clip at the neck of the aneurysm occluding it completely and thoroughly.

Endovascular Coiling: This involves a small incision at the thigh from which a catheter is placed into the artery in question upto the aneurysm under X-ray guidance. Once inside the aneurysmal sac, metallic coils are packed into the aneurysm until it is completely full blocking blood flow into it and rendering it completely safe.

Both modalities have their own pros and cons. Both modalities are available at Sakra World Hospital and are offered on the advice of the treating Neurosurgeon.

What are Arterio-Venous Malformations?

AVM is an abnormal tangle of dilated blood vessels in spine or brain. If an AVM ruptures, it can cause brain damage, stroke, or death. Some AVMs have no exact symptoms and little or no risk to one’s health or life, while others lay ground for severe and demoralizing effects when they bleed.

 
AVMs are dangerous for 2 reasons:

1)  They can bleed as their friable thin blood vessels are subjected to the high pressure of the cerebral blood circulation. The bleed can result in a stroke with loss of function, loss of consciousness, or even death if not tended to surgically.

2)  They short circuit the blood flow to the normal brain tissue as they offer less resistance to the flow of blood. Hence normal brain is starved of blood supply and can die giving rise to infarcts (also strokes).

What are the common symptoms of an AVM?

Common symptoms of AVMs include:

  • Vision problems
  • Severe headache similar to migraine
  • Weakness in arms or legs
  • Confusion
  • Paralysis
  • Unexpected, severe back pain
  • Seizure
  • Weakness of muscle in facial area or body
  • Numbness in entire body
  • Dizziness

How can AVMs be treated?

AVMs are managed in 3 ways:

1. Surgery: here the entire structure is removed under an operating microscope. This is the most effective and commonly used technique for treatment with excellent results.

2. Embolization: here a glue like thick fluid is used to ‘clog up’ and finally solidify the blood vessels in the AVM thereby eliminating the chances of them bleeding or short-circuiting the brains blood supply. Embolization is nowadays used along with surgery or radiation therapy and rarely done alone as it does not completely destroy the AVM resulting in recurrence.

3. Radiation Therapy: RT is used for specific types of AVMs where surgery cannot be offered. The effects are equally good but it takes time to show good results.

The modality required will be decided by the treating neurosurgeon. All modalities are available in Sakra World Hospital.  

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Dr. Satish Rudrappa.

Director - Neurosciences, Senior Consultant Neurosurgery, Head - Dept. of Spine Surgery,
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Dr. Swaroop Gopal.

Senior Consultant - Neuro Surgery & Director - Neurosciences
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Dr. N Chandrashekar.

Consultant - Brain & Spine Surgeries And Neuro Trauma
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Consultant - Neurology & Epileptology

Dr. Saravanan S.

Consultant - Neurology
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