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Cerebral Arteriovenous Malformation Embolization

A vascular malformation is an abnormal collection or tangle of blood vessels. The malformations, which usually are genetic in origin, restrict or alter blood flow and are associated with the degeneration of neurons.

In some such tangles, arteries, which supply oxygen-rich blood to tissue, are interconnected with veins, which move oxygen-depleted blood back to the heart and lungs. The capillaries, the tiny vessels that deliver oxygen to cells and usually separate arteries from veins, are absent. This abnormal passage of blood is called a fistula, and malformations with such artery-to-vein connections are called arteriovenous malformations (AVMs).

Symptoms

AVMs are uncommon; approximately 2500 new cases of symptomatic AVMs are identified each year in the United States, but it is not known how many people have them but have not yet experienced symptoms. Symptoms usually appear in mid-life and slightly more often in men than in women. When AVMs do become symptomatic, however, they often present a serious problem. The most frequent presenting symptoms of an AVM are those related to an intracranial hemorrhage?bleeding in the brain — a serious neurological emergency. Between 50 and 75 percent of patients with an AVM will have the malformation identified after a hemorrhage. Another common presenting symptom is seizure, especially in patients with large AVMs.

Diagnosis

Angiography, which provides an image of the blood flow in the brain, is the most important diagnostic tool for AVMs; it provides important information about both the location and structure of the malformation. Specialized forms of angiography also can be used to provide greater detail. Computed tomography (CT) and magnetic resonance imaging (MRI) scans often are used for diagnosis as well.

Treatment

In addition to microsurgical resection, in which the AVM is removed, and radiosurgery, in which a focused beam of radiation is used to form scar tissue that blocks off the AVM, an interventional neuroradiology procedure called endovascular embolization also is used. A clot or other structure that blocks a blood vessel is called an embolus, and the creation of an embolus for therapeutic reasons is called embolization.

Like other interventional neuroradiological procedures, embolization involves the insertion of a catheter, or tube, through an artery in the groin. The tube is guided up through the blood vessels to the site of the AVM, where it delivers a liquid embolic agent similar to glue that clogs up the malformation to restore normal circulation. Embolization often is used in conjunction with microsurgical resection or radiosurgery; once all or part of the AVM has been removed from circulation, its resection becomes easier.

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