What is a vascular malformation?
A cerebral vascular malformation is an abnormal communication between an artery and a vein in the brain. The normal communication between artery and vein is through capillaries. In the capillaries the metabolic exchange takes place where oxygen and glucose pass to the brain. In vascular malformations this tissue is replaced by another pathological tissue called nidus which is a set of vessels that have no metabolic function and the arterial blood passes directly to the venous blood.
What causes vascular malformation?
Cerebral vascular malformation is a congenital alteration, that is to say, it appears from the moment of birth. It is not a hereditary disorder. This congenital alteration is due to a developmental disorder in the vascular tree that occurs at a certain moment of embryological development.
How do we know if we have a vascular malformation?
The clinical expression of a cerebral vascular malformation is cerebral hemorrhage. This cerebral hemorrhage, depending on its volume and the area of the brain where it is located, can manifest itself as a more or less significant headache or an altered level of consciousness that can even lead to coma. This coma may even be accompanied by a focal neurological deficit such as hemiplegia. The second most common form of presentation is epileptic seizures, which appear in patients who have never had an epileptic seizure. These seizures are due to a phenomenon of ischemia in the cerebral cortex where the arteriovenous malformation is located. Both cerebral hemorrhage and epileptic seizures are reasons for the patient to go to a hospital. A third form of clinical presentation is headache. This is usually significant and persistent in patients who have never had a headache before or who have had a headache other than the one they are suffering from at the moment. These patients consult with the neurologist and the neurologist may suspect a phenomenon of cranial hypertension and may even detect papillary edema. Whether he has it or not, he prescribes the performance of an MRI which is the ideal test to diagnose an arterio-venous malformation. Once the malformation has been diagnosed, he usually complements it with an arteriographic analysis, and with these two tests he sends the patient to the neurosurgeon.
What does the treatment consist of?
The treatment of cerebral vascular malformations is mainly surgical. At present, a multidisciplinary team deals with this pathology. This team consists of neurosurgeons, neurologists, interventional neuroradiologists and radiosurgeons. The treatment approach varies in each case depending on the size, structure and location of the vascular malformation in the brain. The simplest malformations, type 1 and type 2, are exclusively surgical. Type 3, 4 and 5 malformations can be treated neuroradiologically, by embolization of the nidus with thrombosing material and complemented with radiosurgery or conventional surgery.