Brain dural arteriovenous fistula treatment decisions involve continued observation or complex neurosurgical operation. What are relative risks of bleeding from BDAVF? Sometimes endovascular neurosurgery is a preferred treatment method.
Transcript of video
Brain dural arteriovenous fistula treatment includes endovascular embolization and open brain surgery. Cerebral dural arteriovenous fistula causes include unknown vascular event that caused fistula formation. Video interview with top expert in endovascular neurosurgery. Dr. Peng Roc Chen, MD. Top cerebrovascular neurosurgeon explains strategies for brain dural arteriovenous fistula treatment. Medical second opinion confirms that brain dural arteriovenous fistula diagnosis is correct and complete. Medical second opinion helps to choose the best treatment for cerebral arteriovenous fistula. Get Medical second opinion on cavernous angioma and be confident that your treatment is the best. BDAVF. Dural arteriovenous fistula can cause pulsatile tinnitus and sleep problems. You have to discuss with your doctor whether you can exercise with cavernous malformation. Sometimes untreated cavernous angioma can be vigilantly observed. Brain cavernous angioma in parietal region can be treated with endovascular embolization or open neurosurgery. Brain dural arteriovenous fistula treatment. 1234 (Skull Base Neurosurgeon and Endovascular neurosurgeon, University of Texas) Dr. Peng Roc Chen, MD. Treatment of brain dural arteriovenous fistula (dural AV fistula, BDAVF) is different. Brain dural arteriovenous fistulas are classified as “subtype 1” of classification of the general vascular malformation category. 85% of brain dural arteriovenous fistulas can be treated with endovascular embolization. Embolization of brain dural arteriovenous fistula via artery or vein can be very successful in patients, and patients can do very well. Some of brain dural arteriovenous fistulas (BDAVF) have very low risk of repeat bleeding into the brain. But BDAVF can cause constant noise in the ear. Patients with dural AV fistula might not sleep well. They have to change their lifestyle. 1234 But some patients with brain dural arteriovenous fistulas (BDAVF) have very troublesome symptoms.They have a risk of bleeding into the brain. Dr. Peng Roc Chen, MD. Those patients deserve good treatment (endovascular embolization of brain dural arteriovenous fistula). Endovascular embolization methods do not work well for several specific subtypes of brain dural arteriovenous fistula. Neurosurgical treatment is the best method to help those patients. For some patients a combination of endovascular embolization and open brain surgery can be used. Treat brain dural arteriovenous fistula. Very good results can be achieved by combining endovascular and open neurosurgery methods to treat some BDAVF. For cerebral cavernous malformation the risk of hemorrhage (bleeding) is higher. Typical risk of bleeding from cerebral cavernous malformation is 1% to 5% per year. Risk of bleeding from cavernoma depends on its location in the brain. Some of cerebral cavernous malformations can be observed. Treatment of other cerebral cavernous malformations can be safe and successful. Seizures can be a symptom of cerebral cavernous malformations in some locations. Surgical removal of cavernomas is possible for many of locations of the brain. Sometimes patient has seizures. Brainstem cavernous angioma is a difficult location to treat such lesions. Brain cavernous malformation is located inside the brainstem. Also cavernous malformation of the basal ganglia is another example of cerebral cavernous angioma that is difficult to treat. Decision has to be made very carefully and judiciously. How to treat brainstem cavernous malformation and basal ganglia cavernous malformation. Skull base neurosurgeon must have very sophisticated surgical skills to treat these cavernous angiomas successfully. It is important to make a crucial decision whether to continue to observe brainstem cavernous malformation and basal ganglia cavernous malformation. You sometimes have to treat these lesions surgically. Sometimes skull base neurosurgeon decides to treat the lesions surgically. Some surgeons can achieve very good treatment results. 1234 Dr. Peng Roc Chen, MD. Let us summarize our discussion about brain dural arteriovenous fistulas and cerebral cavernous malformations. It is very important to assess the risk of adverse events (bleeding, stroke) correctly for a particular type of particular patient. You must do careful and full assessment of patient’s situation. Decision to continue observation or to proceed with active treatment can be made. The combination of open brain neurosurgical operations and endovascular embolization methods to treat brain dural arteriovenous fistulas or cerebral cavernous malformations is used. It can often achieve the best results for the patient. Matching of skill and experience of neurosurgeon with the difficulty level and location of patient’s lesion is crucial. This is how you achieve best treatment results. 1234 Yes, that is exactly correct. I strongly emphasize that very careful and correct assessment of patient’s individual situation is a key to successful treatment of any cerebrovascular disease. It is important to use principles of evidence-based medicine to evaluate and treat patients with cerebrovascular disease. However, for many cerebrovascular diseases, there is no high quality evidence about best approaches to treatment of patients. There are many specific situations. It includes treatment of brain dural arteriovenous fistulas or cerebral cavernous malformations. There is still controversy about the best methods of treatment of many cerebrovascular diseases. Because of this controversy, most situations of cerebrovascular disease are not black or white. Dr. Peng Roc Chen, MD. Most cases of cerebrovascular disease require careful assessment of balance between risks of treatment and risks of natural progression of the disease. That includes treatment of brain dural arteriovenous fistulas or cerebral cavernous malformations. Brain vascular malformations cause bleeding or seizures. Sometimes the risk of complications from the progression of disease process is higher than the risk of surgical operation or endovascular treatment. Then you know the correct answer about what to do. But it is crucially important to determine. The best modality of treatment has to be the best for this particular patient. Then a surgeon can choose the less risky modality to treat this patient. It may be open brain surgery or endovascular embolization. Decision whether to treat the patient is crucial. How to treat the patient is particularly important for those patients. They have the cerebrovascular problem that was discovered by accident. These patients may face the risk of problems from their cerebrovascular disease. Brain dural arteriovenous fistulas or cerebral cavernous malformations can happen in the future. It very important to correctly determine their brain bleeding risk. Treatment of cavernous angiomas and brain dural fistulas is very much evolving. Dr. Peng Roc Chen, MD. I think that multimodality treatments are the best. It is a combination of open neurosurgery and endovascular treatment. It is the most balanced way to treat patients with cerebrovascular problems. It will be best for the patients in many situations. Brain dural arteriovenous fistula treatment. Intervene or observe? Endovascular embolization or open brain surgery? Combination? How to find neurosurgeon?