BRAIN ARTERIO-VENOUS MALFORMATION (BAVM)

Q1 What is BAVM?

Brain AVM is direct connection between brain arteries and veins through abnormal bunch of vessels. These abnormal vessels tend to bleed and cause intracranial hemorrhage.

Q2 How patients with BAVM presents?

Patients with BAVM presents with:
1. Intracranial hemorrhage
2. Seizures
3. Focal neurological deficit
4. Venous hypertension and raised intracranial pressure

Q3 What are indications for treating BAVM?

Indications to treat BAVM are:
1. Intracranial bleed
2. If no bleed but patient is symptomatic, do Cerebral Angiography and see for weak points like fistula, aneurysms and deep venous drainage, if present treat it.

Q4 How to treat BAVM?

BAVMs can be treated either by Surgery, Embolization or Radiotherapy.

Q5 What are advantages of Embolization over Surgery and Radiotherapy?

Advantages of embolization are

1. Complications are less compared to surgery.

2. We get immediate results unlike radiotherapy.

3. Complete cure can be achieved.

Q6 How BAVM embolization is done?

Step 1: Femoral artery is punctured and sheath is placed in femoral artery. Then through it guiding catheter (blue) is placed into neck vessel.

Step 2: Microcatheter (yellow) is taken through guiding catheter in the feeding artery distal to normal arteries.

Step 3: BAVM is embolized with liquid embolic agent.

Step 4: –Finally microcatheter, guiding catheter and sheath are removed.

CASE 1: 32yrs male with intracranial haemorrhage and left frontal BAVM

CASE 2: 35yrs female with intracranial hemorrhage and left occipital BAVM