Minimally invasive endovascular embolization for cerebral, dural, and spinal arteriovenous malformations โ performed by Dr. Suresh Giragani.
A cerebral AVM is a mass of abnormal blood vessels in the brain where arteries connect directly to veins through a central "nidus" (nest), bypassing the normal capillaries. Some people are born with the nidus, and it tends to enlarge over time because the veins cannot handle the high pressure of the arteries, forming a mass of worm-like vessels capable of bleeding. Brain AVMs are most likely to bleed between the ages of 10 and 55, after which the risk drops rapidly.
When an AVM haemorrhages, it usually bleeds a limited amount, unlike the larger hypertensive haemorrhages seen in other strokes. Many patients have small, sometimes multiple haemorrhages.
All brain AVMs that present with bleeding should be treated; for unruptured AVMs the evidence is conflicting and the decision is individualised.
Closes the AVM from inside the vessels using liquid embolic agents like Onyx, PHIL, or Squid.
Surgical removal, used alone or combined with embolization depending on the AVM.
Targeted radiation therapy, another option in the multi-modality approach.
A ruptured brain AVM can be treated by one or a combination of these methods.
A dural arteriovenous fistula is an abnormal connection between the meningeal arteries and the brain's veins, in the coverings (dura) of the brain. DAVFs usually develop as a consequence of clots in the brain's veins. Over time, high pressure in the brain circulation causes symptoms of raised brain pressure, including headache and visual loss. In some cases the affected veins can burst under pressure and cause a brain haemorrhage. Dural AVFs are diagnosed by digital subtraction angiography (DSA).
Most spinal AVMs occur in this age range.
Back pain with progressive sensory loss and leg weakness, over months to years.
Sudden weakness, numbness, or paralysis from haemorrhage โ usually under age 30.
Spinal angiography maps the vessels and is mandatory before embolization.
A brain arteriovenous malformation (AVM) is a tangle of abnormal blood vessels where arteries connect directly to veins through a central nidus, bypassing the normal capillaries. Its main danger is bleeding in the brain. Brain AVMs most often bleed between the ages of 10 and 55.
Symptoms depend on location and bleeding. They include seizures (sometimes the first sign), headache, and loss of neurological function. When an AVM bleeds, it usually bleeds a limited amount, and many patients have small, sometimes multiple, haemorrhages.
Before age 55, a brain AVM has about a 3 to 4% chance of bleeding each year, with a death rate around 1%. After a first bleed, the risk of another rises to about 20% in the first year, then falls back toward 3 to 4% over the following years.
Ruptured AVMs should be treated, using one or a combination of endovascular embolization, microsurgery, and stereotactic radiation. Embolization closes the AVM from inside the vessels using liquid agents such as Onyx, PHIL, or Squid, and can completely close smaller AVMs with accessible feeders.
Onyx embolization seals a brain AVM from the inside. A fine microcatheter is guided into the AVM and a liquid embolic agent (Onyx) is injected to block the abnormal vessels, with no open brain surgery. It is especially effective for smaller AVMs and is often combined with surgery or radiation for larger ones.
A DAVF is an abnormal connection between the covering (dural) arteries and the brain's veins, often developing after a vein clot. It can cause headache, visual loss, and, if a vein bursts, brain haemorrhage. It is diagnosed by DSA and treated with endovascular embolization.
About 85% of spinal AVMs cause slowly progressive symptoms over months to years, such as back pain with sensory loss and leg weakness. In 10 to 20% of cases, usually in younger patients, there is sudden weakness, numbness, bladder or bowel problems, or paralysis from bleeding.
Spinal AVMs are mapped with MRI and spinal angiography, then many can be treated with minimally invasive endovascular embolization. Lesions that have bled, especially within or pressing on the spinal cord, may also need surgery.
At Neuro & Vascular, brain, dural, and spinal AVMs are treated by Dr. Suresh Giragani, Consultant Interventional Radiologist at Apollo Hospitals, Jubilee Hills, Hyderabad, with over 18 years of experience in neurovascular embolization including Onyx.
Book a consultation with Dr. Giragani, or send your scans and reports for a specialist second opinion.