Brain Arteriovenous Malformations (AVMs) are rare but serious conditions, affecting about 10 in 1,00,000 people globally. These abnormal bunch of blood vessels in the brain, most often since birth, usually are detected once they rupture, a ruptured AVM is serious medical emergency often seen with brain hemorrhage which can lead to seizures, weakness of one side of body, unconsciousness and other  severe complications.

Endovascular treatment is a crucial tool for diagnosis and treatment of ruptured or unruptured brain AVMs. It can oftenbe curative or used in conjunction with other treatments like surgery or radiation. This minimally invasive procedure is done in a neuro vascular cathlab involves navigating a series of progressive smaller catheters and wires  through blood vessels ( arteries or veins)  to the AVM site and delivering substances to block off abnormal vessels.

Endovascular treatment aims to reduce the risk of bleeding, preserve brain function, and potentially lead to the complete closure of the AVM, offering hope for improved outcomes in patients with these challenging conditions.

What is an Arteriovenous Malformation (AVM)?

Arteriovenous malformations (AVMs) are abnormal tangles of blood vessels in the brain. These malformations disrupt normal blood flow and can lead to serious medical complications, including bleeding in the brain (hemorrhage) and neurological symptoms such as seizures and headaches.

Dr. Vikas Gupta is a skilled Hybrid neurosurgeon renowned for treating artery venous malformations (AVMs). With a focus on minimally invasive techniques, Dr. Gupta aims to provide the best possible outcomes for his patients. He is known for his compassionate approach and commitment to delivering personalized care, making him a trusted choice for those seeking treatment for AVMs.

How Does Endovascular Treatment Work?

Endovascular treatment for brain AVMs involves accessing the abnormal blood vessels through a catheter inserted into an artery in the groin or arm. Using real-time X-ray guidance (fluoroscopy), the interventional neurosurgeon navigates the micro catheter through the blood vessels to the site of the AVM.

Once the catheter reaches the AVM, the interventional neurosurgeon very meticulously delivers various chemicals specific to treat the malformation. These substances can include embolic agents, which block off the abnormal vessels and reduce blood flow to the AVM, causing it to shrink over time.

Dr. Vikas Gupta, an expert in endovascular treatment for brain AVMs, emphasizes the importance of advanced tools in this procedure. He explains, “We utilize catheters, microcatheters, and guide wires to navigate the blood vessels to reach the AVM. These tools are designed to be flexible and precise, allowing us to deliver embolic agents or other substances directly to the abnormal vessels, effectively treating the malformation while minimizing risks to surrounding brain tissue.”

What Are the Benefits of Endovascular Treatment for Brain AVMs?

This treatment offers several benefits:

• Minimally Invasive: This treatment is minimally invasive compared to traditional open surgery, which requires a craniotomy (opening of the skull). This means less pain, shorter hospital stays, and faster patient recovery.
• Reduced Risk of Bleeding: By blocking off the abnormal blood vessels, endovascular treatment minimizes the risk of bleeding in the brain, a significant concern for patients with AVMs.
• Preservation of Brain Function: Endovascular treatment aims to preserve normal brain function by targeting only the abnormal blood vessels, leaving healthy brain tissue untouched.
• Potential for Complete AVM Closure: In some cases, endovascular treatment can lead to complete closure of the AVM, eliminating the risk of future bleeding.
• Complimentary to Other Treatments: Endovascular treatment can be combined with other treatment modalities, such as surgery or radiosurgery, to achieve the best possible outcome for the patient.

“Endovascular treatment allows for a personalized approach to treating brain AVMs by tailoring the procedure to each patient’s needs. We can use advanced imaging techniques to precisely map the AVM’s blood vessels, allowing us to target the treatment more effectively. Additionally, we can adjust the treatment plan based on factors such as the AVM’s size, location, and the patient’s overall health, ensuring the best possible outcome for each individual,” added Dr. Vikas Gupta.

“After struggling with symptoms from my brain AVM for years, I underwent endovascular treatment with Dr. Vikas Gupta. The procedure was smooth, and I experienced significant improvement in my symptoms. I highly recommend Dr. Gupta for his skill and dedication.” – Rahul Kumar.

What Are the Risks and Complications?

While endovascular treatment is generally safe, there are risks associated with the procedure, including:

• Stroke: There is a small risk of stroke during or after the procedure, which can result in temporary or permanent neurological deficits.
• Bleeding: There is a risk of bleeding at the catheter insertion site or within the brain.
• Allergic Reaction: Some patients may be allergic to the contrast dye used during the procedure.

How Much Does Endovascular Treatment Cost For Brain Avms In India?

Here is an approximate cost range:

It’s important to note that these costs are approximate and can vary. The cost can vary based on several factors, including the complexity of the case, the hospital or clinic, the doctor’s fees, and the specific treatment approach. Other expenses, such as medications and follow-up care, should also be considered.

Conclusion

I have been using this technique very successfully particularly in ruptured brain AVMs, that is what is called Hybrid neurovascular surgery. Once a brain hemorrhage is suspected to be caused by ruptured bAVM a cerebral DSA is done to study the supply and drainage of blood vessels. If patient is neurologically serious due to pressure caused by brain hemorrhage, first a surgery called decompressive hemicraniectomy (DHC) is done to relieve pressure on the brain. After patient stabilizes than a ruptured brain AVM embolization is done followed by surgical decompression of hemorrhage and microsurgical excision of bAVMfollowed by replacement of bone flap in one session.

We have been offering this hybrid technique for cure of ruptured AVMs, for last two decades or so. Endovascular treatment is a valuable tool in managing brain AVMs, offering a less invasive option with promising outcomes. While the procedure carries some risks, the potential benefits, including reduced risk of bleeding and preservation of brain function, make it a compelling choice for many patients. Collaboration between patients, their families, and a multidisciplinary team of healthcare providers is essential in determining the most appropriate treatment approach for each case.

FAQs about Endovascular Treatment for Brain AVMs

1. Is the endovascular treatment painful?

The diagnostic part that is DSA is performed under local anesthesia and curative part of endovascular treatment is performed under general anesthesia.

2. How long does the procedure take?

The duration of the procedure can vary depending on the complexity of the AVM and the treatment approach. It typically takes a few hours.

3. What is the recovery time after endovascular treatment?

Recovery time varies, but most patients can expect to stay in the hospital for a few days after the procedure. Complete recovery may take several weeks.

4. Can the treatment be repeated if needed?

In some cases, endovascular treatment can be repeated if necessary to achieve optimal results or address new developments in the AVM.

5. Is this treatment suitable for all types of brain AVMs?

Endovascular treatment is not suitable for all types of brain AVMs. The treatment approach depends on the AVM’s size, location, and characteristics. A multidisciplinary team of healthcare providers will determine each patient’s most appropriate treatment plan.

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