Invasive Cyberknife Radiosurgery can cure complex brain AVM’s
Dr Aditya Gupta
AVM (Arteriovenous malformation) is a medical disorder which involves wrong connection of arteries and veins which leads to swelling of blood vessels mainly in brain or spine but can affect other organs like hands, foot.
Arteries are responsible for taking oxygen-rich blood from the heart to the brain. Veins carry oxygen depleted blood back to lungs and heart. When AVM disrupts this critical process the surrounding tissues may not get enough oxygen and the affected veins and arteries may rupture and weaken. Such AVM’s if in the brain can be deadly as rupturing of the AVM can lead severe bleeding in the brain causing stroke, haemorrhage and ultimately death. However, timely diagnosis and treatment can help in the prevention of permanent damage or loss of life.
What are the signs and symptoms of it?
Brain AVM may not cause any signs and symptoms until it ruptures, resulting in bleeding in the brain. But some people may experience signs and symptoms other than bleeding related to AVM, thus in any such cases, do not ignore the symptoms as it can lead to serious complications. Depending on the location of the AVM in the brain some of the common signs and symptoms include –
·Severe headaches in one part of the head
·Weakness, numbness or paralytic attack
·Difficulty in speaking or vision loss.
·Seizures or epilepsy like attacks
·Confusion and unsteadiness, among many other minute symptoms
Though anyone can be born with this condition (congenital), but some of the risk factors of developing it in later stages of life may include –
Age – Usually the symptoms of brain AVM begin at any age but are more prominent in the age bracket of 10 to 45 years. Over a period of time, if left undiagnosed or untreated, AVM damages the brain tissues and its effect multiply with time.
Gender – Various studies are reports are suggestive that brain AVM is more common in males as compared to their counterparts.
Genetic history – Though cases of AVM have been reported in families, but the reason involving any genetic factor is still unclear. It may be possible to inherit any medical condition that may predispose one towards development of Vascular malformations like AVM
Diagnosis and Treatment for AVM
High-resolution MRI is very useful in diagnosis of presence of Brain AVM. Thereafter the lesion is studied in detail by cerebral angiography. This test uses a special dye called a contrast agent injected into an artery. This dye is highlighted of blood vessels to better show them on X-rays.
Embolization is a known technique for treating AVM with surgery. But sometimes due to its complex location and size, the surgery may require high expertise and skills, where a new and advanced procedure is useful. However, typically the entire AVM cannot be treated in one single session, it requires multiple sessions.
Cyberknife radiation surgery reduces the long term risks of AVM hemorrhage by delivering high doses of radiation to shrink it completely. With the use of latest image guidance and computer assisted robotic system, the procedure delivers multiple beams of high frequency radiation to the actual site from all the directions. Another advantage is that the missile guided technology can also automatically track and detect any movement in patient to correct the delivery of radiation beams to the exact treatment location.
During the procedure, the robotic arm slowly moves around the patient and they will not feel anything. The patients can be as relaxed as always in their own dress comfortably listening to music. This is a single session treatment lasting for 30 minutes.
The process being completely pain free and 100% safe (with no side effects), also eliminates the use of anesthesia or other invasive head frames for stabilizing (as in case of other traditional techniques like gamma knife). Almost in 99% of the cases patients recover within single treatment and get back to normal activity immediately after the procedure.
The AVM typically disappears in 90% of the patients after 3 years of Cyberknife radiosurgery, and this slow and gradual occlusion of AVM is actually the safest for the body.
Sometimes, AVM may present with bleeding, or may be small in size and present on the surface of the Brain. In these cases, Microsurgical removal of AVM may be the best option, and provide an immediate cure with a high degree of safety.
(The author is Director – Cyberknife, Artemis Hospital, Gurugram)