शैडोइंग अभ्यास: Arteriovenous Malformation (AVM) Treatment | Brigham and Women's Hospital - YouTube के साथ अंग्रेजी बोलना सीखें

What happens when a person comes in with a brain AVM?

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What happens when a person comes in with a brain AVM?

We talk about the natural history.

That means if we do nothing about this brain AVM,

what's going to happen next?

Are they going to have a hemorrhage the next day?

Or is it going to be five years or never?

Well, unfortunately, we don't always know.

We don't have a crystal ball.

So we try to make predictions that will help this person,

this patient and their family,

make the best decisions for their health.

So what goes into that decision?

The size of the AVM,

the location of the AVM,

the hemorrhagic status, and a host of other risk factors that we go through in our clinic visit.

Then we decide, well, AVMs that have never ruptured have about a 2.4% risk of hemorrhage every year.

So if you add that up, it gets significant.

Sounds small, but for a 20-year-old,

over the next 60 years of his or her life,

2.5% each year can add up very, very quickly.

And for each hemorrhage, there could be a 30% or higher percent chance of morbidity or major mortality.

So what are the ways that an AVM can be treated?

Well, first, it can be observed.

That is one observational treatment,

understanding the risk benefits and alternatives that go into that.

But I think another way that we specialize here at the Brigham and Women's Hospital is surgery.

What are the advantages of surgery?

Surgery means we can go in,

delicately dissect out the vessels that need to be preserved for normal function of the brain

and remove the vessels that are abnormal,

the ones that would potentially lead to a hemorrhage or death.

And we do that under a microscope,

and we take our time.

I always turn off the clock when we do this part of the operation,

because it really just doesn't matter.

It means that we get this thing out in one piece,

and that patient will do well, because that's a cure.

And they can walk out of the hospital and never have to worry about this again.

So when it works, it's fantastic.

And depending on the grade of the lesion,

one through five, the risks change.

So the smaller the size, the less risk.

The bigger the size, the higher the risk.

Another way that we treat brain AVMs at Brigham and Women's Hospital is through radiosurgery,

radiation, directly shrinking down the AVM,

perhaps in those AVMs that aren't amenable to surgery.

Now, the good part about brain AVM radiation is that there's very little upfront risk.

The not so good part is it takes years for the radiation to work and may not always work.

And so we have to judge the balance and risk of all of these management decisions.

Another way that brain AVMs can be treated is endovascular,

something we also do, that I personally do and my partners do.

We put a catheter inside of the blood vessels of the brain,

go inside, find the AVM,

fill it with embolic material to try to close it down.

And usually that's used as an adjunct or a helpful hand for surgery.

So the multidisciplinary approach is nothing new to neurosurgery or to medicine in general,

but for brain AVMs it's quite useful because the different modalities of treatment are done by different specialists.

I myself do both endovascular and surgery,

but we have colleagues that are gonna help us with the radiation effects.

We get together on Thursdays in a conference and discuss each patient,

their goals, the lesion, and how we may be able to help as a team.

And then we bring that information back to the patient and say,

well, these were the opinions,

but what is best for you?

And in this circumstance, in our hospital,

in this patient, it's all very individual.

You know, you can't just open a book and say,

what's the right answer for a brain AVM?

It's just much too complex.

It has to do with the person's goals

and what they're going to do in their life and what age they are and what is their risk tolerance.

So each one of these conversations has to be individualized.

We keep track of all our patients.

I know all of them from the very beginning.

I want to know my results so that we know we're doing a good job.

So we benchmark ourselves against anyone.

And if you come to me,

I'll show you what the last 100 were like.

And I think that's really important.

My goal for any patient that I encounter is

that I deliver the best and absolute best possible care that I can for that patient.

That means it's got to be individualized to understand that patient.

Where are they coming from?

Whose family are they? their mother,

father, son, daughter, what matters to this person?

Because in our profession, it's not just the disease we wanna treat,

we wanna help the person.

We want them to get back to life, be functional.

Whatever it is their goals are become my goals.

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