Vasular Malformations of the brain and spine.

Arterio-Venous Malformations (AVMs)

AVMs are abnormal collections of blood vessels in the brain that contain a direct connection between the arteries (that take blood away from the heart at high pressure) and veins (that take blood back to the heart at low pressure).

They are usually congenital and are frequently asymptomatic.

They may bleed (causing intracerebral haemorrhage) or cause epilepsy.

The main indication for treatment is previous bleeding or rarely intractible epilepsy.

The bleeding risk is thought to be 1-2% per year if the AVM has not bled and double this once it has bled however the bleeding risk in the first year is

Treatment must be considered on an individual basis and involves discussion between neurosurgeons, neuroradiologists, neurologists and radiosurgeons.

Management may involve:

Observation (conservative management)
Endovascular embolization
Microsurgical excision
Gamma Knife Radiosurgery

or any combination of the above.

Cavernoma or Cavernous Malformation

Cavernomas are pockets of abnormal blood vessels that may occur in the brain or the spinal cord.

They are frequently asymptomatic but they may bleed and cause neurological problems.

If they are in the top part of the brain (the cerebrum), they may also cause epileptic seizures.

There is no medical treatment available other than controling seizures.

Indications for surgery are cavernomas that have bled and cavernomas that are causing intractible epilepsy.