Question

Describe in details the angioarchitecture evaluation while planning treatment in a case of brain arteriovenous malformation.

Hint:

Accurate angioarchitecture evaluation helps tailor the treatment plan, improving the chances of a favorable outcome.

Answer 1

The angioarchitecture evaluation of brain arteriovenous malformations (AVMs) is essential to plan appropriate treatment strategies, including surgical resection, embolization, or radiosurgery.
Step 1: Angiographic Imaging:
- Digital subtraction angiography (DS is the gold standard for evaluating the AVM's angioarchitecture. It provides high-resolution images of the feeding arteries, nidus (the core of the AVM), and draining veins. - It helps in assessing the size, location, and vascular feeders of the AVM.
Step 2: Feeding Arteries and Nidus:
- The feeding arteries supply blood to the AVM, and their size and number are important in planning embolization or surgical strategies. - The nidus is where the arteries and veins are connected and is the primary target for treatment.
Step 3: Draining Veins:
- The draining veins are essential in evaluating the risk of hemorrhage, as AVMs with direct connections to large veins have a higher risk of rupture.
Step 4: Venous Outflow Evaluation:
- The venous outflow, especially if it involves deep cerebral veins, can be a key factor in deciding whether embolization is feasible or surgery is needed.
Step 5: Multimodal Imaging:
- In addition to DSA, CT angiography (CT and MRI are used to assess the AVM's relation to adjacent brain structures and the potential for surgical access.