Brain arteriovenous malformation (BAVM), also known as cerebrovascular malformation, is a dangerous congenital cerebrovascular disease that occurs when the embryo is 45-60 days old and there is no normal capillary network between the arteries and veins, but only an abnormal mass of malformed vessels. Clinicians classify AVMs according to the size, location and depth of the artery supplying the blood, the size of the malformation, and the depth of the draining veins. The lower the grade, the easier it is to treat; the higher the grade, the more difficult it is to treat. Our Huashan Hospital commonly uses “Shi’s grading” (in short, every 2.5 cm plus one level, four levels) and Spetzler’s grading (every 3 cm plus one level, functional area plus one level, deep vein plus one level, five levels), as proposed by our patriarch Professor Shi Yuquan.
AVM is usually diagnosed in the following cases: 1. Sudden severe headache during exercise or emotional stress, often accompanied by vomiting, confusion or even coma, numbness or weakness of the arms and legs, severe hemiparesis, inability to speak, and other neurological deficits. Patients with the first bleeding of AVM can survive 80%-90% of the time.
2. Convulsions, also known as seizures. About half of AVMs have seizures.
3. Headache. More than half of the patients have a history of headache. The headache is often on one side and may resolve on its own.
4. Gradually increasing neurological impairment.
In these cases, the doctor will recommend CT, MRI or DSA to confirm the diagnosis.
In terms of treatment, there are three types of treatment methods: 1) craniotomy, 2) intravascular embolization, which is also known as interventional treatment, by injecting ONYX and other gel into the malformation to make the malformation completely or partially occluded (in recent years, the development is rapid), 3) stereotactic radiosurgery, which is also known as gamma knife and radio wave knife. These methods can also be applied in combination, that is, comprehensive treatment, usually have better results.