Surgery cuts down AVM risks

Surgery cuts down AVM risks

By Maria Endah Hulupi

JAKARTA (JP): Eighteen-year-old Maulana fell and suffered a
head injury. The doctors allowed him to go home after he received
treatment for it.

Maulana's life returned to normal, but two years later, he
suffered severe headaches, seizures, vomiting and became half-
paralyzed. He was later diagnosed with multiple Arterio-Venous
Malformation (AVM) and was referred to a hospital in Tangerang
for endovascular surgery.

AVM, according to Prijo Sidipratomo, a radiologist at the
University of Indonesia, is a short circuit which takes place
because the artery, which is responsible for transporting red
oxygenated blood from the heart, feeds blood directly to the vein
carrying deoxygenated blood, without passing through capillary
vessels.

This condition will increase pressure in the vein and, over
the years, damage vessels, making them prone to ruptures, which
in turn, affects connecting veins and arteries. The area of the
connection is called the shunt and the location of the AVM is the
nidus.

"AVM is asymptomatic and patients know they have it only when
it ruptures. However, patients may complain of headaches,
seizures, blurred vision, partial paralysis and speech problems,"
said Prijo, who is also a radiologist with Siloam Gleneagles
Hospital, in Tangerang.

A neurosurgeon with the hospital, Eka J. Wahjopramono, warned
that failing to detect AVM could lead to ruptures and in turn
cause hemorrhaging in the brain.

"This would put pressure on a part of the brain, causing
stroke-like symptoms, which could be fatal," he said during a
news conference to mark the hospital's fifth anniversary.

AVM, he said, carried a significant risk of disability and
death among younger people.

So how can we know if a person has AVM or not?

Prijo said AVM could be confirmed by a computer-assisted
tomography (CT) scan, an angiogram to give an image of the
brain's major blood vessels and magnetic resonance imaging (MRI)
to generate the brain's image using a magnetic field.

AVM treatments include microsurgery, open surgery or a
combination of the two, depending on the size of the AVM, its
location and the degree of the shunt.

Microsurgery, also called endovascular surgery, is performed
by inserting a long, thin, flexible micro catheter through a
femoral artery (in the leg) and directing it to the artery that
feeds the AVM area. Once the catheter is there, a balloon is
released and expanded to separate the veins and arteries and the
catheter is then withdrawn. The catheter can also release glue on
the nidus to block the vessels that feed the AVM.

"The advantages of the procedures are it doesn't require a
craniotomy or opening the skull. It is a low-risk procedure and
can reach deep-seated vascular problems in the brain," Prijo
said.

Doctors, according to Eka, would reconsider the need to
perform surgery to remove the abnormal vessels of AVM once it has
been glued.

"If bleeding occurs, open surgery can be performed for
hematome evacuation and decompression," Eka said.

Aside from AVM, Prijo said endovascular surgery could be
performed to treat various neuro-vascular irregularities that
block the flow of blood, which supplies oxygen and nutrients to
the brain. It can also be performed on aneurysms (a dilation of
the artery in the brain that can lead to stroke caused by
hemorrhaging), arterial clogging due to plaque that builds up in
the brain's blood vessel or leading to the brain and blood clots
that lodge in the brain vessel, which can also lead to stroke.

So far, endovascular surgery can be done at Gleneagles, which
is equipped for the procedure. The hospital aims at developing
neuroscience in Indonesia to provide proper treatment for neuro-
related diseases without having to obtain it abroad.

Performing endovascular surgery in Indonesia would
significantly slash costs with the only major expenses being the
use of imported disposable tools, such as balloons, catheters and
coils.

"But most importantly we would be able to provide immediate
treatment, which is important to treat neuro-vascular
irregularities. Delayed treatment can be serious and fatal," Eka
said.

The hospital has also set up the National Brain Foundation,
which is funded by companies grouped under the Lippo Group, to
help finance patients with neuro-vascular problems.

"Every year, we plan to support treatment for 100 patients,"
Eka said.