1. Do all cerebrovascular malformations require treatment? Can they be treated conservatively with medicine?
Cerebrovascular malformation is a congenital abnormality of cerebrovascular development, which can be divided into five types.
(1) arteriovenous malformations.
(2) cavernous hemangioma.
(3) capillary vasodilatation.
(4) venous malformations.
(5) varicose veins.
Among the above five categories of cerebrovascular malformations, arteriovenous malformations are the most common, followed by cavernous hemangiomas. In principle, all arteriovenous malformations require surgery because of the potential risk of hemorrhage. However, because some patients with arteriovenous malformations have extensive lesions and are located in important functional areas, surgery is risky and can be considered for follow-up if the patient is asymptomatic. In general, drug treatment is not effective for the prevention of the above diseases, but may only relieve the clinical symptoms caused by the above diseases (such as headache, epilepsy, etc.).
2.What are the main drugs for conservative treatment? Can they prevent cerebral hemorrhage?
Cerebrovascular malformation is a congenital disease, which cannot be prevented by drugs, let alone prevent brain hemorrhage by drugs. The so-called “conservative treatment drugs” are only symptomatic treatment for the symptoms of the disease itself (headache, epilepsy), which “can only treat the symptoms, not the root cause”.
3.When is surgery needed for cerebral arteriovenous malformation? Is surgery necessary once brain hemorrhage occurs?
There is no unified standard for the indications of surgical treatment for cerebral arteriovenous malformation, but it is recognized that surgery is recommended for arteriovenous malformations that have bled and those with neurological deficits (e.g. motor, sensory, visual field and speech impairment); for asymptomatic vascular malformations, the surgeon can assess the size, location and drainage of the malformation and determine the risk of bleeding and surgery. For asymptomatic vascular malformations, the surgeon may decide whether surgery is needed by assessing the size, location and drainage of the malformation and the risk of bleeding and surgery.
4.What are the surgical treatment options?
There are three main types of surgery for cerebral arteriovenous malformations: microsurgical resection, vascular interventional embolization and gamma knife radiation therapy. For example, interventional embolization first to reduce the blood supply of cerebral arteriovenous malformations and then craniotomy, which can reduce the risk of bleeding during craniotomy for arteriovenous malformations; or partial embolization of arteriovenous malformations first, for the residual part of the malformation to take gamma knife radiation therapy.
5.When is craniotomy necessary? What are the advantages and disadvantages? What is the effect?
At present, craniotomy is still the gold standard for the treatment of intracranial arteriovenous malformations. For arteriovenous malformations with small malformation mass, superficial location and non-functional area, the complete resection rate can reach more than 90%. However, the disadvantage is that the surgical damage is greater and bleeding is more frequent. Currently, more and more neurosurgeons are adopting partial embolization of the artery supplying the vascular malformation before craniotomy in order to reduce the surgical risk. For unbleeding arteriovenous malformation located in deep brain tissue (which cannot be reached by craniotomy) and functional area, considering its high surgical complications, craniotomy is usually not recommended.
6.In what cases can vascular intervention be performed? What are the advantages and disadvantages? What are the results?
Interventional treatment can be considered for arteriovenous malformations that are more compact and supplied by a single blood supply artery, as well as for arteriovenous malformations that are expected to have high complications from surgical resection or cannot be resected. The advantage is that it is minimally invasive, with only a “needle-eye” sized incision in the groin area, and the patient can be discharged within a few days after the procedure. The disadvantage is that there is a low cure, may require multiple embolization treatment.
7.What kind of cases are suitable for Gamma Knife treatment? What are the advantages and disadvantages? What is the effect?
Gamma knife is also an option for brain arteriovenous malformations with a diameter of less than 3 cm and for which craniotomy is not possible. It uses the principle of radiation to induce slow occlusion of the malformed vessels. The advantage is that it is non-invasive, but the disadvantage is that the occlusion process is slow, about 1-2 years on average. In addition, there is a higher risk of bleeding in arteriovenous malformations that have bled or in those with arteriovenous aneurysms. In addition, the occlusion rate is significantly lower than that of craniotomy, so it is more often used for interventional treatment or adjuvant treatment of residual arteriovenous malformations after craniotomy.
8.When the malformed blood vessel is located in the deep part of the brain or the third ventricle, can craniotomy still be performed?
For arteriovenous malformations located in the deep brain or the third ventricle, craniotomy is possible, but the risk of surgery is very high.