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ARTERIO-VENOUS
MALFORMATION(AVM)
 DIRECT CONNECTION BETWEEN ARTERY AND
VEIN BYPASSING THE CAPILLARY
 DECREASED O2 DELIVERY
 INCREASED O2 IN VENOUS BLOOD
AVM
 DEPENDING ON THE FLOW
 LOW FLOW
 HIGH FLOW
 PRIMARY
 SECONDARY(LOW FLOW PROGRESSES TO HIGH
FLOW IN ADULT )
AVM
 CONGENITAL
 ACQUIRED
 THERE ARE ANGIOGRAPHICALLY OCCULT
VASCULAR MALFORMATION
 OSLER-WEBER RENDU SYNDROME  15-20%
THIS NIDUS SITE IS PRONE FOR
RUPTURE AS THE FLOW INCREASES
THE THIN WALLED VEIN CANNOT
HANDLE THE BLOOD
 SINCE THERE IN NO DAMPENING OF FLOW IN
THE BLOOD, AS THERE IS NO CAPILLARY.
TYPES OF AVM
 PARENCHYMAL AVM
 YELLOW  PIAL AVM
 RED  PARAVENTRICULAR AVM
 GREEN SUBCORTICAL AVM
 MIXED
 DURAL AVM
 MIXED (DURAL AND PARENCHYMAL AVM)
CLINICAL PRESENTATION
 HEMORRHAGE(INTRAPARENCHYMAL>INTRAVENTRICU
LAR HEMORRHAGE >SUBARACHNOID HEMORRHAGE )
 MASS EFFECT
IF ON TRIGEMINAL NERVE  TRIGEMINAL
NEURALGIA(ALWAYS MRI)
SEIZURES
ISCHEMIA BY STEAL
INCREASED ICP
Arterio venous malformation(avm)
INVESTIGATION
 CT
 MRI ANGIOGRAPHY
SPETZLER MARTIN GRADING
MANAGEMENT
 SURGICAL RESECTION
 EMBOLISATION
 Onyx-18, 34  AVM
 ONYX 500 - ANEURYSM
 STEREOTACTIC RADIOSURGERY
 FOR DEEPER LESION OF LESS THAN 3 CM
POST OPERATIVE COMPLICATION
 NORMAL PERFUSION PRESSURE BREAKTHROUGH
 Swelling or hemorrhage due to loss of autoregulation
- Patient pretreated with propanolol 20mg QID TO
MINIMISE THIS EFFECT
 OCCLUSIVE HYPEREMIA.
 MAY BE DUE TO OCCLUSION OF DRAINING VEIN OR
DUE TO THROMBOSIS (DELAYED EFFECT)
 POST OPERATIVELY
 CATHETER ANGIOGRAPHY AT 1 YEAR AND AT 5
YEAR AFTER TREATMENT
THANK YOU

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