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Arteriovenous Malformation (AVM) Surgery in Bhubaneswar

Arteriovenous Malformation (AVM) Surgery

Arteriovenous Malformation (AVM) Surgery in Bhubaneswar

Arteriovenous malformations (AVMs) result from the abnormal development of a group of blood vessels, causing arteries and veins to twist and form direct connections, bypassing normal tissue. This irregularity typically occurs during pregnancy or shortly after birth. Most individuals with AVMs initially show no symptoms or difficulties; rather, the condition may be discovered incidentally during unrelated medical examinations. However, if one of the blood vessels within an AVM ruptures, immediate medical intervention is required. Sometimes, AVMs are only detected after someone has passed away, during autopsy examinations. It's worth noting that if symptoms do not appear before the age of 50, they may never manifest.

FAQ's

The symptoms of an AVM vary depending on where the abnormality is located. AVMs have a greater risk of bleeding. AVMs can become larger as a person grows. They frequently grow larger during puberty, pregnancy, or following a shock or injury. An AVM can cause pain, ulceration, bleeding, and, in severe cases, heart failure.

An AVM may be mistaken for a capillary malformation (sometimes known as a "port wine stain") or an infantile hemangioma.

The following are physical symptoms:

  • Buzzing or rushing sounds in the ears
  • Headache: Although no distinct type of headache has been discovered,
  • Backache
  • Seizures

Symptoms may include:

  • Loss of feeling in certain areas and muscle weakness
  • Visual changes and facial paralysis
  • Drooping eyelids
  • Problems speaking
  • The sense of smell changes
  • Changes in motion
  • Dizziness
  • Feeling unconscious
  • Bleeding
  • The blue colour of the fingers 

Yes, there is a chance that an arteriovenous malformation (AVM) can come back after surgery. This can happen if small parts of the AVM or its blood vessels are not completely removed during the surgery. Sometimes, new abnormal blood vessels may also form later on.

To monitor for any signs of the AVM returning, it's important to have regular follow-up appointments and imaging tests after surgery. If the AVM does come back, your doctor will discuss the best options for further treatment, which may include more surgery, a minimally invasive procedure called endovascular embolization, or targeted radiation therapy.

Diagnosing an arteriovenous malformation (AVM) involves several tests to accurately identify and assess the condition. Here are the primary tests typically used:

Imaging Tests

  • MRI (Magnetic Resonance Imaging): Provides detailed images of the brain or spinal cord to identify the presence of an AVM and its size, location, and effect on surrounding tissues.

  • MRA (Magnetic Resonance Angiography): A specialised type of MRI that focuses on blood vessels that help to visualise the AVM’s structure and blood flow.

  • CT Scan (Computed Tomography): Provides cross-sectional images of the brain or spine to detect abnormalities. It’s useful in emergencies to quickly assess bleeding.

  • CTA (Computed Tomography Angiography): A type of CT scan that focuses on blood vessels, and provides detailed images of the AVM’s structure and blood supply.

  • Cerebral Angiography (Digital Subtraction Angiography - DSA): The most definitive test for diagnosing AVMs, provides highly detailed images of blood vessels and blood flow in the brain or spine.

Surgical Removal:

In this procedure, a neurosurgeon opens the skull or spine to access and remove the AVM. This is often the best option if the AVM is in a place that can be safely reached and removed. Surgical removal can completely cure the AVM if it's entirely excised.

Endovascular Embolization:

This minimally invasive procedure involves inserting a catheter through a blood vessel, usually in the groin, and guiding it to the AVM. A substance like glue, coils, or particles is injected to block blood flow to the AVM. Endovascular Embolization can reduce the size of the AVM and lower the risk of bleeding, making it easier to manage or remove surgically.

Radiosurgery (Stereotactic Radiosurgery):

Radiosurgery uses focused, high-dose radiation to target the AVM, causing the abnormal vessels to thicken and close off over time. This is a non-invasive option that works well for small to medium-sized AVMs that are deep or hard to reach surgically. It has a lower risk of immediate complications, but it may take months or years for the AVM to close completely, and there is a risk of radiation damage to surrounding tissues.

After AVM surgery, the region around the incision may be uncomfortable and numb for approximately a week, and it may itch while it heals. In addition, there may be swelling and bruising around the eyes, as well as general weariness.

For 2 to 4 weeks, or until your doctor thinks it's safe, avoid intense activities like biking, jogging, weight lifting, and aerobic activity.

AVMs can be entirely treated with surgical excision. If the entire AVM is effectively removed after surgery, it is called cured. Radiosurgery can also entirely eliminate an AVM over time (2–3 years); however, the efficacy rate is lower (50–80% depending on its size).

If an AVM has leaked into the brain, surgery may be indicated. If the AVM is deep in your brain, surgery may be impossible without causing considerable harm to healthy brain tissue. In this scenario, radiosurgery for AVM embolisation may be a safer choice.

Treatment options for brain AVM include:

  • Microsurgery

  • Endovascular embolisation

  • Stereotactic radiosurgery, or a combination of the above surgeries.

If an arteriovenous malformation (AVM) is not treated, several potential consequences can arise:

  • Risk of haemorrhage

  • Stroke-like symptoms

  • Cognitive and functional impairments

  • Neurological symptoms such as headaches, seizures, vision problems, and neurological deficits like weakness or numbness. 

Vigorous exercises are not beneficial for those suffering from AVM. Therefore, it is advised to avoid vigorous exercise. People on AVM drugs should avoid strenuous exercise since it can raise blood pressure. A doctor can advise you on what exercises to do and what to avoid.

Seizures affect 12 to 57% of patients with brain arteriovenous malformations (AVMs), and even after surgical removal of the lesion, epilepsy may persist. If left uncontrolled, epilepsy can lead to significant morbidity and reduced quality of life.

AVM-related aneurysms can put you at risk of rupturing (bleeding) and experiencing bleeding symptoms. Therefore, a hemorrhagic stroke due to AVM affects your memory and may lead to dementia, impairing thinking, mental processing, and speech comprehension. 

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