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A cerebral vascular malformation (AVM) is a collection or tangle of blood vessels in the brain that can restrict or alter blood flow.
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Often, the condition is present at birth and can worsen over time. In some cases, patients will present with seizures, bleeding, headaches and other neurological symptoms. The condition can also be found when a CT or MRI is performed for other reasons. Brain AVMs are difficult to treat and may require a few therapies to be successful.
Along with cerebral AVMs any tumor that is vascular (tangle of blood vessels interconnected) in nature is difficult to remove or treat. It requires a multidisciplinary approach that begins with shrinking the tumor by decreasing the blood supply through what is known as embolization. By decreasing the size of the tumor, surgeons may be able to remove it surgically. If the tumor cannot be removed surgically, an embolization will most often result in a smaller tumor that reduces pain and give the patient a better quality of life.
Embolization is the actual closing of blood vessels. While it can be the sole source of therapy, it is more often used in conjunction with surgery. During the embolization procedure, the physician inserts a catheter through a puncture in the large blood vessel in the leg called the femoral artery.
Using imaging guidance, the catheter winds to the site of the abnormality through the circulatory system. Once at the site, an embolizing based material is released through the catheter to seal the blood vessel. A variety of materials are available and are selected on the type of vascular disorder being treated.
For a cerebral arteriovenous malformation (AVM), a test injection of the embolic agent is done first, followed by a neurological function to ensure the patient’s brain will not be affected by the embolization. Then, vessels connected to the AVM will be injected. Large AVMs may require several embolizations over the course of several weeks to completely treat the malformation.
The length of the procedure is dependent on the complexity of the AVM or tumor. Most patients go home the same day, but some patients may need to remain in the hospital for further monitoring.
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