a neurosurgeon explains how to diagnose and treat the disease

Cerebral arteriovenous malformation (AVM) is a congenital alteration that occurs when the arteries and veins of the brain connect directly, without the presence of capillaries, which are the vessels responsible for gradually reducing the speed of the blood before it reaches the cerebral veins. When this intermediate step is absent, as in AVMs, arterial blood reaches the veins at high pressure, generating abnormal hemodynamic flow that can weaken the vessel walls, increasing the risk of various problems.

In addition to bleeding, which can lead to death in the most severe cases, the malformation can cause persistent headaches, convulsions, loss of strength or sensitivity in certain parts of the body, changes in vision or even cognitive changes. “It all depends on the size of the AVM and the region of the brain in which it is located,” explains neurosurgeon Feres Chaddad, professor of neurosurgery discipline at UNIFESP and head of the vascular neurosurgery sector at the São Paulo Hospital and the Beneficência Portuguesa Hospital in São Paulo.

The diagnosis is normally made through imaging tests, either after the presence of symptoms, such as seizures and hemorrhages, or from incidental findings during routine consultations. The main methods include computed tomography (CT), magnetic resonance imaging (MRI), and cerebral angiography. “The latter is considered the reference, because it makes it possible to precisely map the AVM vessels and identify their supplying arteries,” argues the specialist.

With these results it is possible to evaluate the hemorrhagic risk and define the best treatment strategy, which depends on the characteristics of the injury, since there is no drug capable of curing an AVM. “The options are: clinical monitoring, when the malformations are small, asymptomatic and low risk. There is also vascular embolization, when a catheter is injected to close the local circulation. Another procedure is stereotactic radiosurgery, which uses concentrated radiation to gradually close abnormal vessels, and is more indicated for small AVMs or those located in difficult to operate areas. And, finally, complete ablation of the AVM by microsurgery”, explains the neurosurgeon.

The choice between treating or simply monitoring an AVM depends on several factors: the patient’s age, the location of the AVM, the bleeding history and the risks associated with each approach. “And it should be noted that brain AVM is a congenital lesion and not a tumor. Often the patient can live for decades without showing symptoms, but the risk of serious hemorrhage still exists. Therefore, upon discovery of the disease, the evaluation must be immediate and individualized in order to be able to propose the best strategy and guarantee the safety, well-being and quality of life of the patient”, concludes Feres Chaddad.

Website: https://www.instagram.com/fereschaddad/