Anterior venous malformation brain
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ANTERIOR VENOUS MALFORMATION (BRAIN). Nurul Fatiehah bt Asmui PZM0044/12. Introduction. AVM is vascular abnormalities which consist fistulous connection of arteries and veins Normal condition: artery-capillary-vein

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Anterior venous malformation brain





  • AVM is vascular abnormalities which consist fistulous connection of arteries and veins

  • Normal condition: artery-capillary-vein

  • AVM: bypass normal brain tissue, and divert blood directly from arteries to the vein

  • Most of AVM do not grow

  • Less than 1 percent having AVM in general population

  • There are four types

  • Anterior venous malformation

  • Cavernoma- capillary enlarged

  • Venous malformation- vein enlarged

  • Hemangioma- blood vessel occur at surface of brain

  • Can be detected using CT-scan, angiography MRI scan

  • CT scan can determine the location and the condition of lesion but MRI is better- more detail for soft tissue

  • Angiography is mandatory, provide accurate location of lesion


  • intracerebral hemorrhage ( more than half of patients)

  • Seizure (45-50%)

  • Headache and localized pain

  • Difficulty in speech, motion and vision (little case)


  • Spetzler-Martin grading scale

    - evaluate AVM in order to determine the right treatment can be done

  • Majorly based on

    -size of lesion

    -location of the lesion

    -venous drainage

    -general condition like age

  • Have 5 grade- grade 1 is small, superficial and non-eloquent cortex, grade 4 is essentially inoperate and grade 5 is really deep and surround by critical organ

  • Medical therapy-for patient who has no dangerous symptom or inoperate AVM

    -not for cure, just to reduce the symptom

    - Anticonvulsant (decrease occurrence of seizure)

  • Surgery- easily operate lesion

    - usually being followed by other treatment

  • Radiosurgery-used high energy radiation to destroy abnormal vessel

    -ideal for small AVM and locate at critical area that cannot be operate

  • Embolization-blocking abnormal blood vessel using microcoil for example

    -used for deeper AVM that cannot be operate

    -used before surgery to reduce blood flow

Treatment outcome
Treatment Outcome

  • Follow up procedure being done after treatment

    -usually used angiography but new technology shows that MRI with contrast enhancement also 86.9% accuracy(Lim and Choi (2012))

  • after surgery- only 1.1% shows the reoccurrence of AVM (mustafa, 2009)

  • Seizure free- 81% after surgical, radiosurgery(43%) and embolization(50%) (Hoh BL, 2002)

  • After radiosurgery- obliteration rate is 79% for small AVM and 47% for large AVM (Fredman, 1997)

    - But cured rate for radiosurgery takes time-and show secondary tumor occur due to radiation

  • Past study by Kwon(2000) said embolization shows no significant improvement but recent study by T. Seruga(2009) show by using Onyx (new embolic material) show half successful result.


  • Before treatment-

    -Determine the proper treatment method-

    -based on Spetzler-Martin grading scale

    -general health of patient

  • During treatment

    - tissue damage-wider margin resection of AVM or due to radiation

  • After treatment

    - Hemorrhage from residual AVM and seizure

    -auto regulation of blood vessel