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ANTERIOR VENOUS MALFORMATION (BRAIN)

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)

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  1. ANTERIOR VENOUS MALFORMATION (BRAIN) NurulFatiehahbtAsmui PZM0044/12

  2. 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

  3. 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

  4. 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

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

  6. 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

  7. 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

  8. 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.

  9. 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

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