Prática de Shadowing: Dr. Bernard Bendok: Arteriovenous Malformation - Brain AVM - Aprenda a falar inglês com o YouTube

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So an AVM is an abnormal tangle of vessels where arteries connect through a tangle of weakened vessels to a vein.

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So an AVM is an abnormal tangle of vessels where arteries connect through a tangle of weakened vessels to a vein.

Normally arteries divide into ever smaller vessels until you get to the capillary level where the vessels are very tiny

and at that level capillaries can unload oxygen and nutrients and pick up CO2 and then from there the blood is collected by small veins that go into ever larger veins that then go back to the heart.

With an AVM however, the arteries connect to a tangle of weakened arteries and that flow goes right into a vein.

So as a result, the veins see arterial pressure.

Normally venous pressure is much lower than arterial pressure, but in AVM the veins are under high pressure and veins don't like high pressure so that tends to lead to inflammation and sometimes aneurysms can form and those aneurysms can lead to rupture.

And when an AVM bleeds that can be occasionally catastrophic or lead to neurological injury.

It would be the equivalent of a column that's designed to hold up a cardboard roof.

Putting a cement roof on that on that column will result of the column collapsing.

So one of the challenges with understanding AVMs and their treatment options is the fact that they're very complicated three-dimensional structures that we often see 2D images and we try to look at 2D images to understand a three-dimensional problem.

So we've been using 3D printing and holography to try to get a better understanding of the M, one, for the benefit of the treating team so that we can better think through what we may or may not be able to do for the patient, but the second is to also educate the patient regarding their problem.

So this is a 3D print of an AVM.

Here you can see some normal vessels, and what you can see here is what I would call the bowl of spaghetti.

These are fragile vessels that can pop easily.

They're not used to, or they're not designed to carry high pressure so they can break and rupture, and that can cause brain bleeding.

So as we look at this model, we can start to rotate it and think about what vessels are coming into it.

That's what we call feeding arteries.

Abnormal vessels that come into this tangle, this spaghetti bowl, so to speak.

And what you don't see on this model clearly is that there's usually a vein coming out.

And when we go in with surgery, our goal is to separate this mass from the surrounding brain tissue safely while preserving the normal arteries and removing it from the patient.

That may or may not be safe, depending on the specific anatomy of that patient.

Additionally, an AVM of this size, for example, it may be very beneficial to inject some glue into the AVM before surgery to make the surgery safer.

So what we would do is under fluoroscopy, we would navigate a very tiny catheter into, let's say, this artery and get into an artery where it would be safe to inject glue into the AVM.

We would watch glue percolate into the AVM, plugging up these abnormal small arteries.

And that That may make the surgical plan and the surgical option much easier to implement.

Just like snowflakes, there are no two AVMs that are the same.

Every AVM is different.

It depends on how close you look.

And our treatment plans also have to be unique and uniquely designed to match the needs of the patient.

So the treatment options for AVM include microsurgery.

That's where we, through a cranial opening and using the operating microscope, we can look at the anatomy of the AVM and disconnect the abnormal arteries from the surrounding circulation and remove the AVM.

The second treatment option is embolization, where a catheter the size of an angel hair pasta can be placed into the AVM and glue can be injected to occlude those abnormal vessels to plug them up.

That can be done in some cases to completely cure an AVM, typically for smaller AVMs that have one or two feeders.

The other treatment option for AVMs is radiosurgery, where we use radiation to shrink an AVM.

That treatment has the advantage of being minimally invasive, essentially, and it's an outpatient procedure, but it does take several years to work.

So patients can continue to have risk of bleeding during that period.

But for AVMs that cannot be removed surgically, for AVMs that are in locations that are undesirable from a surgical standpoint, or in patients who cannot tolerate surgery, either due to age or other comorbidities, radiosurgery may be a good option.

Another option for larger AVMs is to use staged radiosurgery, where we treat the AVM in different pieces.

So if an AVM is too big for a single shot of radiation, we can potentially break it up into two or three pieces and do it over the course of three to six months.

And finally, of course, there is an innovative option for some AVMs, and that's proton beam therapy.

And proton beam therapy has been used successfully to treat certain AVMs.

But again, the treatment does take time, and not all AVMs can be occluded with this technique.

So each of these techniques has pros and cons.

It's important for every patient who would like to treat their AVM to really carefully get educated about all those treatment options and how they can potentially work together.

Patients with AVMs should have hope.

AVMs can be scary, but with modern treatments, there has never been a better time in the history of AVM treatment for patients with AVMs.

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Prática de Shadowing: Dr. Bernard Bendok: Arteriovenous Malformation - Brain AVM - Aprenda a falar inglês com o YouTube

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