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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

ANTERIOR VENOUS MALFORMATION (BRAIN)

NurulFatiehahbtAsmui

PZM0044/12

introduction
Introduction
  • 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
slide3

Can occur at any site of body, but critical at brain

- brain control the body function

  • AVM is develop during embryonic stage but people start showing symptom when they around 20 till 40 years old
  • AVM is not heredity disease
slide4

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
symptoms
Symptoms
  • intracerebral hemorrhage ( more than half of patients)
  • Seizure (45-50%)
  • Headache and localized pain
  • Difficulty in speech, motion and vision (little case)
treatment
Treatment
  • 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
slide7

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.
complication
Complication
  • 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

ad