What is the best treatment for arteriovenous malformation?
Answered by: Dr SK Pandya
Jaslok Hospital & Research Centre, Mumbai
Q: My daughter is 20 years old. She has arteriovenous malformation (AVM) in the right side of the frontal lobe of brain. She frequently gets headache too. What are the possible and best means to cure it and where?
A:Since her chief complaint is headache, and she is young, it is worth considering eliminating it from the circulatory tree of blood vessels.
There are two options:
Performing an operation and removing the malformation after disconnecting it from the arteries that supply blood to it and the veins that drain blood away from it. This can be performed in any major neurosurgery centre. The operation carries risks similar to those in any major brain surgery.
Obliterating the arteries that bring blood to it through a process known as therapeutic embolisation. This is usually performed by specialists and comes under interventional neuroradiology. An arterial catheter is inserted into the large artery of the thigh (femoral artery) and guided into the large artery supplying blood to the relevant half of the cerebrum (internal carotid). A finer catheter is then passed through the large catheter and guided, in turn, into each of the arteries feeding the AVM. In each instance, care is taken to see that the artery carries blood only to the AVM and not to normal brain. Once the fine catheter is satisfactorily placed, a material that will cause the blood in the artery to clot is injected into it. Thus the arteries conveying blood to the AVM are obliterated one by one. Once all blood supply to the AVM has been stopped, it is excluded from the vascular tree and poses no danger.
Interventional neuroradiologists are now available in several major hospitals. In Mumbai, they are available at the K. E. M. Hospital in the public sector and Jaslok and H. N. Hospitals in the private sector.