1. Do all cerebrovascular malformations require treatment? Can they be treated conservatively with medicine?
Small vascular malformations and unruptured vascular malformations can be temporarily observed, and vascular malformations in functional areas also need to be focused on. There is no effective medication available.
2.When is surgery necessary? Does it mean that once brain hemorrhage occurs, surgical treatment is needed?
Vascular malformations with symptoms are best operated, and vascular malformations with bleeding are also indications for surgery.
4.What are the ways of surgical treatment?
The surgical treatment is vascular malformation resection. For vascular malformations in important areas that sometimes cannot be removed surgically, the main blood supply artery is also temporarily clamped to reduce the risk of bleeding.
5.When is craniotomy necessary? What are the advantages and disadvantages? What are the results?
Interventional embolization treatment does not require craniotomy and is less risky, but only partial embolization of the vascular malformation, which cannot solve the problem of removing the malformed abnormality.
6.When can vascular intervention be performed? What are the advantages and disadvantages? What is the effect?
(1) Those who are not suitable for direct surgery.
(2) Lesions located in important functional areas, such as the motor area of the brain, language area, brainstem, etc., which will produce serious complications and sequelae after surgery.
(3) Those with high blood flow lesions, severe blood theft (blood reflux), high bleeding from surgical resection or the possibility of hyperperfusion syndrome after surgery
Advantages of interventional therapy.
(1) Less invasive to the whole body. It can be performed under local anesthesia by puncturing the femoral artery at the root of the thigh and introducing the treatment catheter.
(2) Less traumatic to brain tissue, no craniotomy.
(3) Short operation time.
(4) No damage to the normal perivascular penetrating vessels, which can reduce the complications of the procedure.
The disadvantage of interventional therapy is that the indications are narrow, sometimes the malformation cannot be completely embolized and surgery is needed, and the higher cost requires a certain economic base.
Treatment effect: the current effect of vascular embolization is still relatively ideal, there are generally patients receiving treatment.
7.What kind of situation is suitable for Gamma knife treatment? What are the advantages and disadvantages? What is the effect?
Gamma knife treatment of cerebral arteriovenous malformation first began in 1971, the effect is satisfactory. After more than two decades of clinical practice, it was found that the high rate of postoperative vascular closure, in particular, can significantly improve the quality of postoperative survival of patients, and has now become the preferred treatment option for certain cerebral arteriovenous malformations. Compared with surgery and endovascular embolization treatment, the advantages of Gamma Knife treatment are that the patient is non-invasive, painless, safe, with fewer and milder complications, and can be done in an outpatient setting without the risks of open surgery and general anesthesia.
The treatment mechanism of Gamma Knife is that the endothelial cells of blood vessels are damaged by a certain amount of radiation irradiation, causing the proliferation and fibrosis of collagenous fibrous tissue in the vessel wall, resulting in the formation of intravascular thrombosis, occlusion of the vascular nest, abnormal perfusion stops, and the circulation returns to normal. Due to the imperfect development of the malformed vascular mass, occlusion of the malformed vessels is more likely to occur after the same dose of irradiation. After 1-2 years of treatment, the occlusion of cerebral arteriovenous malformations disappears while the normal cerebral vessels are not affected. Gamma knife treatment of cerebral vascular malformation cure rate and surgery and vascular interventions are the same, comprehensive literature reports, gamma knife treatment of arteriovenous malformation occlusion rate of 30% to 50% in the first year, 70% to 85% in the second year, the third year up to 90%. The smaller the volume, the higher the rate of occlusion, the better the outcome. The relief of clinical symptoms is generally more satisfactory.
Complications after gamma knife treatment are mainly postoperative edema reaction and the possibility of rebleeding, postoperative edema reaction is generally transient, appearing around 6 months after treatment, and can be eliminated with appropriate dehydrating hormone therapy. Theoretically, as long as the vascular malformation is not completely occluded, there is a possibility of rebleeding. According to statistics, the rebleeding rate after gamma knife treatment is 2.6% in the first year, decreases to 1% in the second year, and generally does not rebleed in the third year. At present, more than 40,000 cases of cerebrovascular malformations have been treated with Gamma Knife worldwide, and satisfactory results have been achieved. The cure rate is 82-95%.
Cerebrovascular malformation is the need for accurate diagnosis and correct treatment, the current effect of surgery patient recovery rate can reach 90%, so we still recommend that patients are given treatment as soon as possible after a clear diagnosis. We hope this article can give you the right guidance.