Brain Aneurysm Prognosis

The objectives and Objectives in the Direction of Malformations of Arteriovenous of Brain

The objectives and Objectives in the direction of Malformations of Arteriovenous of Brain

 

By P. Lasjaunias, Brugge of ter of G. OF K., and HAS. Berenstein

 

The decisions retrieving themselves to the treatment of endovascular of the malformations of arteriovenous of brain (BAVMs) demands complete the news in comparison with the circumstances clinics and the characteristics of imagery including the angioarchitecture of the AVM just like the brain. With these factors in has objections an analysis clinico-morphologique can be done to formulate the better project for therapy, that could include embolization just like the other methods. The angioarchitecture of the AVM will determine the two the approach to the lesion and the foreseen chances to attain the therapeutic objective. &Nbsp; The various methods of treatment and the competences of available treatments can change in the time, while the original objective, as resolved by clinic and the characteristics of angioarchitectural, probably will remain the same.

 

The indications for Treatment of BAVMs

 

The discovery of a BAVM in a patient does not represent an automatic indication for the treatment. The various attempts were let the programs of analysis conceive of decision to determine the risks of conservative one vs. the active treatment of BAVMs. All are based on the capacity to treat the lesion from the standpoint purely surgical. They did not consider the role of embolization as an assistant predopedratoire, an only method of treatment (when completes malformation deletion is obtained with a permanent agent), or as the party of a combination of treatments.

 

While some surgical investigators began realizing that not all BAVMs carries the same risk for the healthy future the recommendation for the direction continued to be the same. &Nbsp; to obliterate itself (to remove) the AVM and uses a method that has the highest chance of accomplish that in a framework: surgery.   Limiting factors are surgical arrangement (the size of AVM, the location, etc.), and the morbid character and the surgical mortalities therefore foreseen associated with the not to act in conformity to proof growing in surgical and the literature of endovascular that all BAVMs are not the same and does not carry a similar risk for the future symptoms and therefore the treatment risk The natural history of this special lesion.

 

Aimed Embolization is an average viables, sure and effective of therapy in the fitting circumstances. At the same time while constructing a reasoning for the direction strategy based on the data of the literature the one would go counts that a lot of the reports warn necessarily because of the reference models. Although such given (the rate of hemorrhagic presentation, the natural history, etc.) very well can support their recommendations for the strategy of treatment of their referred group of patients, it cannot do a request of a different one (the population based or other) referred the group of patients of BAVM. What's more when a strategy of treatment is to be considered the should take into account the available local expertise (endovascular, neurosurgical and radiosurgery) just like their patients of BAVM of file of treatment. Their treatment data should be known and should be compared to the published norms and time to time is reconsidered.  

 

One in passing (during to sort) discovered microphone bavm cortical in an older patient with the disorder of HHT has not the same prognostic as a big thalamic AVM in a young patient presenting with the progressive neurological deficit and therefore their direction should be different. Nevertheless the former can easily healed with the low morbid character and no mortality while the last one can be only partially embolized; the treatment strategy should not be based on our capacity to attain the remedy but rather on the post advantage clinic therapeutic foresaw progressively and his secured price from the viewpoint of the risks.

 

We recommend therefore that what's more of the news clinics big care is given to the analysis of the studies of imagery and in particular the angioarchitecture. &Nbsp; angiogram is executed with the objective to obtain a study completes vascular system: the provision to the AVM, the malformation angioarchitecture, his drainage streaks, associated vascular additional lesions, the statute of the circulation subsidiary and the drainage streaks The normal brain.

 

The news obtained by the investigation of angiographic will play a role key in decides the need for the treatment. The last one will be based on the demonstration of proof of weakness in the angioarchitecture, that can indicate to an instability potentielle. These information are analyzed then jointly with the other factors as the age of the patient and the lesion location.

 

The presence of an aneurysm or arterial pseudoaneurysm associated on the nutrition pedicle, or in the nidus, the thrombose veineuse, the exit restriction, hyperpressure streaks, streaks the pockets or expansions, all will be factors favoring the active intervention. But when the risk of total elimination of the malformation (by embolization, the microsurgery, or the therapy combination), is prohibitive, then a strategy of different direction will need to be considered as aimed partial embolization.

 

Patient educations and Continuation

 

An important party of the direction of BAVMs in passing discover is to instruct the patient. The it is important to furnish them with the news as for the natural history as it can apply to their special position, just like the options of treatment and the associated risks that are known to exist in the environment of local treatment. If no significant weaknesses are shown in the angioarchitecture then a strategy of treatment can be proposed of not to treat the patient in this moment, and reassure the patient that it is counted to take a normal productive life without the restrictions. Nevertheless the evolution is not linear and biological events that can produce them unforeseen changes that can remain since a long time infra clinic. Give after is therefore crucial in all the patients including of those for which a decision of not to treat was chosen. Give after is ordinary clinic and with the imagery (the MRI), but if changes clinic or of imagery is noted then repeated angiography could be indicated.

 

This extract is adapted of: Lasjaunias, P., Berenstein, HAS. (and Al.) : Surgical Neuroangiography. Heidelberg: Springer-verlag, Flight. 2, Ch. 10, 2004. Reprinted with the permission of the editor.

 

Refusal: This item is for the goals informationnels and should not be considered a substitute for the counsel, the diagnosis, or the professional medical treatment. Always to look for the counsel of your doctor or your other supplier of qualified health with any question that you can have as for a medical condition.

 

Authors

 

Rock Lasjaunias, M.D., Ph.D., the Former Boss of kitchen of Service of Vascular Neuroradiologie Diagnotique and of Therapeutique to Hospital, University Center of Bicetre in France. Brugge of ter of G. of Karel, M.D., FRCPC is the head of the Division of Neuroradiology to Toronto Hospital of the west in Ontario, Canada. Alejandro Berenstein, M.D., is the director of Institute of hyman-newman of Israel of Beth for Neurology and Neurosurgery (the INN) to the Hospital of Roosevelt to New York.