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What is the management of AV malformation in the brain?

Q: My 10 year old nephew suffered a severe headache and became unconscious while playing at home last year. CT scan, MRI, & finally angiography showed an AV malformation on the left side. He was operated and small cluster & clot were removed. We were told that 2nd angiography would be done after 3 months for the confirmation of removal. He was improving his speech day by day as he developed stammering during that episode. After 3 months the angio showed the presence of residual and he was advised reoperation at the earliest. He was reoperated and residual was removed. But again the doctor is asking for a 3rd angio for the confirmation of residual if any. It is quite tedious and confusing for the parents, both emotionally as well as financially (secondary). How many angios will be required to confirm the absolute removal of AV malformation? Also, we were told by other social agencies that there are side effects too of angiography. I request you to kindly suggest some other measures for this. Give other curable measures for the exact confirmation for AV malformation.

A:Your doctor is trying to ensure that your nephew has been adequately treated and that there is no residue of his abnormal blood vessels in the brain. It is often difficult to be sure at surgery that the entire cluster of abnormal blood vessels has been removed. This is why a check angiogram is so useful. Its utility was proven in your nephews case by the detection of a residue. In all probability this will be the final angiogram and if normalcy has been restored, no further tests will be required. Computerised tomographic angiography and magnetic resonance angiography can also be carried out instead of the digital subtraction angiography (DSA) but the images so obtained are inferior to those on DSA.

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