Congenital arteriovenous connection is a congenital defect in the cerebral blood vessels during creation inside the mother's womb, and it is not hereditary, but rather a congenital defect as it is called. The disease is defined as a direct connection between an artery and a vein, and that the blood flow from the artery does not go to its branches and the tiny capillaries branching from it to nourish the brain tissues, but rather flows directly into the vein that returns it to the heart without benefiting from it. A person may live with this disease naturally and without any symptoms. Therefore, we may discover it when imaging the brain for other reasons, for example, when a head injury occurs and the case calls for a tomography or magnetic resonance imaging of the brain.
When symptoms of the disease occur, they arise from bleeding from the congenital cerebral arterial-venous connection inside the brain. These symptoms include sudden headaches, sudden epileptic seizures, or any neurological symptoms that arise as a result of disruption or damage to the parts of the brain responsible for these symptoms.
The annual bleeding rate from the arteriovenous connection is about 1%, and it increases to 5% every year after the occurrence of the first bleeding.
In the event of a major brain hemorrhage, it may lead to paralysis or sudden death of the patient, especially in adolescence. We diagnose arteriovenous communication after taking the patient's history, computed tomography, magnetic resonance imaging of the brain and arterial magnetic imaging of the brain. And the confirmed diagnosis comes by performing cerebral arterial imaging with cerebral arterial catheters
Treatment of congenital cerebral arterial contact
- Surveillance: This is when the disease is discovered by chance or there is a large arterial and venous connection in a large area of the brain
- Brain microsurgery for congenital arteriovenous junction resection
We recommend this method when bleeding occurs from an arterial-venous connection in the area in front of the frontal lobe, in front of the temporal lobe, or at the back of the posterior lobe, provided that the patient is in good health and has general anesthesia. - Clot of the arteriovenous junction with a colloidal substance
Injected into the artery feeding the arteriovenous connection through a catheter. The success rate of this method by closing the arteriovenous connection decreases with the increase in the size of the arteriovenous connection or its location, especially within the depth of the brain. The expected complications are about 10%, with major neurological symptoms as a result - Gamma Knife Targeted Radiosurgery (without surgery)
This technology is the latest in treating brain diseases and tumors without surgery, without wounds, without anesthesia, without a hospital stay, without complications from invasive surgery, and without hair loss. In one session, the patient can then leave the hospital on the same day of treatment.
This technique is done by installing the 3D stereotactic surgery device on the patient's head using local anesthesia, and by performing 3D magnetic resonance imaging and 3D arterial catheterization to determine the boundaries, size, and coordinates of the arteriovenous focal point inside the brain.
After that, the patient is placed on the bed of the gamma knife, and we direct the gamma rays directed from (201) radial tubes to the focal point of the arteriovenous connection inside the brain. The patient is fully conscious, without pain, and with extreme accuracy, so that the error rate does not reach more than 0.25 mm.
After completing the radiation dose, we remove the stereotactic device from the patient's head, who can leave the hospital on the same day of treatment and return to his usual life the next day.
The success rate of closing the arteriovenous connection is 80-95% during the three years following treatment, and this depends on the size of the focus of treatment, so that the smaller the focus, the greater the therapeutic radiation dose and the success rate of closing it is greater. The percentage of complications is low, and this depends on the sensitivity of the place where the treated congenital arteriovenous connection is located.
Cerebral arteriovenous communication is considered a serious congenital cerebral disease, which poses a great risk in the event of intracerebral hemorrhage.
There is a rate of 2% of cases of bleeding every year, which leads to sudden death in the patient or complications of bleeding and brain damage. The best treatment for this condition is surgical removal, if possible, while avoiding serious complications. And there are 70% of cases that surgical removal has a risk, so the alternative and optimal treatment is the Gamma Knife without surgery, and the success rate of closing the arterial connection during the three years following treatment ranges from 85-95%. And in the event of partial closure after the passage of three years, it is possible to perform another treatment with Gamma Knife to enable complete closure of the arteriovenous connection. More than three hundred cases have been treated at the Amman Naif Gama Center.
As for the method of closing the arteriovenous connection with the arteriovenous catheter, the success rate is low with complete closure of the arteriovenous connection, and therefore it is used in most cases as a first stage to prepare for surgery or to be treated with gamma knife.