Common symptoms of AVM include cerebral hemorrhage, focal neurological deficits, epilepsy, and recurrent headaches. The average annual hemorrhage rate in unruptured individuals is generally 2 to 5%, with a rebleeding rate of 7% in the first year after rupture and 7 to 4% in the second to ten years. An individualized treatment plan is best developed by a physician or team of physicians with knowledge of both neurosurgery, neurointervention and stereotactic radiosurgery (gamma knife, radio wave knife, etc.). And patients are best served by a neurosurgery center that offers all three of these treatment modalities. Here are some common questions from patients: 1. When can cerebrovascular malformations be treated with intervention? There is no standard answer to this question. There are advantages and disadvantages to treatment in the acute phase. The advantage is that embolization facilitates surgical resection, or the combined aneurysm or arteriovenous fistula can be disposed of, reducing the possibility of some rebleeding. The acute phase of hemorrhage may not show the full picture of AVM because of hematoma compression, and in general, the percentage of rebleeding in the acute phase of AVM is not high, so if the patient is in good general condition, he can wait until the hematoma is completely absorbed before doing imaging and interventional treatment. Of course, the condition of patients varies widely, and some of them cannot afford to wait for the development of the disease and must be treated urgently. Therefore, the best time for treatment should be flexibly grasped by experienced doctors. 2.What kind of cerebrovascular malformation is suitable for vascular intervention? Under what circumstances is intervention not suitable? Generally speaking, AVMs with thick blood supply arteries, few roots and relatively concentrated malformation clusters are suitable for embolization, while those with thin blood supply arteries, many roots and scattered malformation clusters, or those located in important functional areas, intervention should be cautious. 3.How should I choose between craniotomy, intervention and stereotactic radiotherapy? This should be carefully analyzed by an experienced doctor or team of doctors according to the specific situation of AVM whether its high-risk pathological mechanism can be relieved or disappeared by interventional treatment, surgical treatment or stereotactic radiotherapy, and then make an appropriate choice. 4.What tests do patients need to do before surgery? CT, MRI and cerebral angiography are generally required; CT mainly looks at hematoma or calcification, MRI is mainly used for cortical function localization and navigation, and DSA is used to analyze vascular architecture and hemodynamics. Of course there are also routine preoperative examinations. 5.How is vascular intervention done? How much does it usually cost? Under general anesthesia, interventional therapy is to puncture the femoral artery, place a microcatheter into the blood supply artery or malformation mass with a coaxial catheter system, and place or inject embolic material to reduce the blood supply to the malformation mass or occlude the malformation mass. General ONYX embolization treatment cost 40-80 thousand, of course, the cost depends on the specific situation. 6.How is the effect of interventional treatment? Is it prone to re-occurrence of vascular malformation? At present, only about 20% of AVMs are completely cured by embolization. However, embolization treatment can contribute to the reduction of bleeding for craniotomy surgery, reduce the risk of surgery and improve the cure rate of stereotactic radiosurgery. 7.What should I do if the interventional treatment fails? Is it possible to perform another intervention? It depends on the specific situation. If there is intraoperative bleeding, emergency craniotomy can be performed to remove the lesion, and in some cases, some other interventions can be used to control the blood flow and stop the bleeding. 8.What are the possible postoperative complications? How to solve? In our ONYX clinical practice also found ONYX has some shortcomings: first of all, the price is more expensive, ONYX in the global sales price is not uniform, because in China in the promotion stage, the dosage is relatively small, so the price is more than twice as expensive than the U.S. mainland. Secondly, the solvent DMSO in ONYX has certain potential vascular toxicity, although usually when injected slowly, patients can tolerate, our animal tests also precisely this, but this is after all the potential shortcomings of this embolic agent, in the intravascular embolization treatment of arteriovenous malformations, aneurysms and other diseases to strictly control the amount of DMSO and injection time, the operation should be slowly injected to achieve effective occlusion The operation should be slow to achieve effective occlusion of the lesion; ONYX liquid embolic agent has a certain corrosive, can make ordinary catheter deformation or damage, so it requires the use of special matching microcatheter. Third, the use of ONYX for the operating physician’s requirements are also high, must allow the microcatheter to reach the malformation of the vascular mass before being able to inject ONYX, otherwise will embolize the normal vessels may lead to serious complications; ONYX use of high access threshold, whether it is China or Europe and the United States doctors, must be approved by the production company’s training before being able to clinical use ONYX.
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