Q: My nephew is 6.5 years old and has AVM. Following are the results of MRI scan: the features are suggestive of arteriovenous malformation in the right temporo-parieto-occipital lobe with feeders from the right anterior middle and posterior cerebral arteries and drainage to the superior sagittal sinus. The MRI was taken at Vijaya Health Centre, Chennai. Following the MRI, he got admitted at Sri Ramachandra Medical Hospital, Chennai where he underwent an DSA Angio test. The report is as follows: four vessel DSA done on 12.07.02. showed large diffuse right parietal avm fed by both ACA, right MCA and right PCA. Doctors have said that the size of the AVM is more than 8 cms and the treatment for the same will be only Embolization until the size is brought down to less then 3 cms and after that Gamma Knife can be undergone. The boy also had fits at the age of 2 years due to high fever.My query is, which hospital in India is best for this AVM treatment and which doctor in India has more experience in treating the same. We are from Chennai but ready to travel any where in India if the facilities and doctors are available to treat this problem.

A:1. The treatment modality mentioned by your doctor is a good option. 2. The second option is of embolisation followed by surgery since, considering the size of the AVM, primary option of surgery as the first modality may entail a lot of risks. 3. One of the best AVM surgeons in the country is Dr D. Rout who is at the Ramachandra Medical College at Chennai. 4. As for embolisation, Ramachandra Medical college as well as Apollo Hospital at Madras have a good interventional neuro-radiology department and they should be able to do a good job. It is very important that wherever you opt for treatment, there should be a competent neurosurgeon well versed with tackling AVM. During embolistaion there is always a likelihood of certain complications which may necessitate surgical intervention (sometimes as an emergency). Within the country, the most suitable place would be 1. Ramachandra Hospital at Chennai 2. Apollo Hospital at Delhi. All the other centres in the country suffer from some shortfalls in the entire management of AVM.