Best Doctors in India for AVM Brain Treatment
- Director – Urology, Andrology & Renal Transplants
- 16+ years
Profile Highlights:
Profile Snapshot of Dr. Shafiq Ahmed
- With over 16 years of experience, Dr. Shafiq Ahmed is a highly skilled urologist and robotic surgeon.
- He has previously worked at some of the best hospitals in India and was instrumental in establishing Renal Transplant Programmes in some of the top hospitals within Delhi-NCR.
- Dr. Ahmed also holds US credentials as a robotic uro-oncologist.
- He has authored numerous book chapters and articles in medical journals on urological diseases.
- As one of the leading urologists, robotic surgeons, and renal transplant surgeons, Dr. Ahmed has trained many upcoming doctors in his field.
- He has also been a prominent speaker at various medical conferences.
- Surgical Oncologist, New Delhi, India
- Over 20 years’ experience
Profile Highlights:
- Dr. S M Shuaib Zaidi is a Senior Consultant of Surgical Oncology at Apollo Cancer Institute of Indraprastha Apollo Hospital.
- His expertise lies in the surgical treatment of cancer of the lungs, esophagus, breast, GI tract, and mediastinal regions.
- Dr. Shuaib Zaidi has close to 2 decades of experience in the field of Surgical Oncology and his expertise lies in Thoracic Oncology surgery.
- Dr. Shuaib is known to have developed an innovative technique known as Radical Neck dissection for head and neck cancer surgery that helps in preserving the marginal mandibular nerve in order to ease the cosmetic outcome of the procedure.
- Dr. Zaidi also has experience in Robotic Surgery and received training in the procedure from IRCAD in Strass Bourg, France.
- Pediatric Cardiac Surgeon, New Delhi, India
- Over 40 years’ experience
Profile Highlights:
- Dr. Krishna Subramony Iyer is one of the best Pediatric Cardiac surgeons in India and specializes in congenital heart diseases.
- He has been practicing pediatric cardiac surgery for over 4 decades and has performed more than 10,000 surgeries through various procedures like double switch operation TAPVC repairs, Fontan and Fontan, arterial switch, and DORV.
- Dr. Iyer has been associated with Escorts Heart Institute for a long time and is responsible for establishing the first pediatric cardiac care program in North India in 1995.
- Plastic & Cosmetic Surgeon, Gurugram, India
- Over 20 years’ experience
Profile Highlights:
- Dr. Adhishwar Sharma is a reputed plastic surgeon, with an extensive experience in plastic and reconstructive surgery.
- He has been associated with various hospitals like Fortis hospital Noida, Batra Hospital, Metro hospital Faridabad, and Central hospital Faridabad.
- He has an interest in Brachial Plexus reconstruction and lymphedema. He has published articles in various international and national journals. He is a member of various professional bodies.
- Endocrinologist, Diabetologist, New Delhi, India
- Over 26 years’ experience
Profile Highlights:
- Dr. Mohammada Asim Siddiqui is one of the best endocrinologists in India. He has an experience of over 26 years in the field. Dr. Siddiqui is active as a senior consultant – endocrinologist with Apollo Centre for Obesity, Diabetes, & Endocrinology, New Delhi.
- Dr. Siddiqui specializes in Internal Medicine & manages Diabetes, Endocrine and Metabolic Disorders, skin allergies, and Piles Treatment.
- His interest in Diabetes mainly focuses on young and gestational diabetes & Post-transplant & post-metabolic surgery diabetes.
- Dr. Siddiqui is also involved in various clinical research and has penned more than 50 articles in national and international journals.
- Robotic Urologist, New Delhi, India
- Over 27 years’ experience
Profile Highlights:
- Dr. Rajesh Taneja is one of the best Urologists in India, having experience of more than 27 years in the specialization. He is practicing at Apollo Hospitals, New Delhi as a senior consultant.
- Dr. Taneja specializes in surgeries to correct Congenital anomalies of urinary organs; Phimosis, PUJ Obstruction, Megaureter, Hydronephrosis, Vesicoureteric reflux (VUR), Hypospadias, Posterior Urethral Valves (PUV), Ectopia vesicae, and others.
- He is formally trained in the Robotic Surgical system and is one of the few urologists performing Robotic urological surgeries in India.
- Dr. Taneja has expertise in the Holmium Laser Enucleation of prostate technique.
- He has written numerous papers in national and international scientific publications.
- Dr. Rajesh Taneja also authored a book titled ‘Interstitial Cystitis’.
Best Hospitals in India for AVM Brain Treatment
Fortis Escorts Hospital, New Delhi
- City: New Delhi, India
Hospital Highlights:
- Over the last 33 years, the Fortis Escorts Heart Institute has set new standards in cardiac treatment with groundbreaking research. It is now known around the world as a centre of expertise for Cardiac Bypass Surgery, Interventional Cardiology, Non-invasive Cardiology, Paediatric Cardiology, and Paediatric Cardiac Surgery.
- The hospital has cutting-edge laboratories that perform a wide range of diagnostic tests in Nuclear Medicine, Radiology, Biochemistry, Haematology, Transfusion Medicine, and Microbiology.
- Fortis Escorts Heart Institute boasts a diverse group of bright and experienced doctors who are backed up by a team of highly qualified, experienced, and devoted support professionals as well as cutting-edge equipment such as the recently installed Dual CT Scan.
- Approximately 200 cardiac doctors and 1600 personnel currently collaborate to manage over 14,500 admissions and 7,200 emergency situations each year. The hospital now has a 310-bed infrastructure, as well as five cath labs and a slew of other world-class amenities.
Rela Hospital, Chennai
- City: Chennai, India
Hospital Highlights:
- RIMC is a multi-specialty hospital in a sprawling area of 36 acres located in Chromepet, Chennai, Tamil Nadu, India.
- The facility has 450 beds including 130 critical care beds, 9 operating rooms, modern reference laboratories and radiology services, and is conveniently located near road, rail and air transportation.
- RIMC is led and managed by world-renowned physicians committed to healthcare.
- RIMC offers the broadest range of clinical care, education, and research. The hospital offers state-of-the-art technology and modern treatment facilities designed to provide health care at an affordable cost.
- Rela Institute is driven by patient needs, comfort and confidence.
CARE Hospitals, Hyderabad
- City: Hyderabad, India
Hospital Highlights:
- CARE Hospitals were established in the year 2000, by CARE Group.
- The multispecialty hospital has 435 beds, including 120 critical care beds, with an annual inflow of 180000 outpatients and 16,000 in-patients.
- The hospital provides specialty medical services in Cardiology, Cardiothoracic Surgery, Pediatric Cardiology, Pediatric Cardiothoracic Surgery, Neurology, Neurosurgery, Nephrology, and Urology.
- The hospital has the first dual source, 128 slice CT scanner (for high precision cardiac imaging) – the first of its kind in south India.
- The hospital offers a wide range of accommodation facilities for the convenience of its varied patient base, ranging from general wards to super deluxe rooms.
Fortis Hiranandani Hospital, Mumbai
- City: Mumbai, India
Hospital Highlights:
- Fortis Hiranandani hospital was established in 2007.
- The hospital is an advanced tertiary care, multi-specialty hospital equipped with 149 beds.
- The hospital is equipped with a super ICU to provide emergency medical care to critically ill patients.
- The hospital is NABH accredited.
- The critical care facility in the hospital is augmented with the state-of-the-art facilities that facilitate speedier diagnosis and efficient monitoring.
- The hospital provides specialty medical services in cardiology, orthopedic science, pediatric science, neurology, diabetic care, urology, nephrology, ENT, obstetrics, gynecology, cosmetic surgery, bariatric surgery, neuro and spine care.
Fortis Hospital, Anandpur, Kolkata
- City: Kolkata, India
Hospital Highlights:
- Fortis Hospital, Anandapur, Kolkata is a world-class super-speciality equipped with the latest technologies in the medical world.
- The hospital is NABH accredited.
- This state-of-the-art facility specializes in cardiology and cardiac surgery, urology, nephrology, neurosciences, orthopaedics, digestive care, emergency care and critical care.
- The hospital, governed by integrated Building Management System (IBMS), has a pneumatic chute system, for quick vertical and horizontal transportation between floors, facilitating speedy transfer of patient specimens, documents, reports, and medicines to the concerned departments.
- The hospital also has a nephrology department with over 28 advanced dialysis units.
Fortis Hospital Banerghatta, Bengaluru
- City: Bengaluru, India
Hospital Highlights:
- Fortis Hospital Bannerghatta, Bengaluru was established in 2006.
- The hospital is a 276 bedded multi-specialty tertiary care facility.
- The hospital specializes in cutting-edge medical technology and dedicated patient care services.
- The hospital is equipped with state-of-the-art technologies like trans-radial angioplasty, trans-abdominal cardiac surgery, and computerized TKR navigation surgery.
- The hospital provides specialty medical services in cardiology, cardiac surgery, orthopedics, neurology, neuro-surgery, GI, and Minimal Access Surgery (MAS).
Fortis Hospital, Malar, Chennai
- City: Chennai, India
Hospital Highlights:
- Fortis Malar was established in 1992 and was formerly known as Malar Hospital.
- The hospital specializes in cutting-edge medical technology and dedicated patient care services.
- The hospital is multi-specialty, tertiary care facility with 180 beds.
- The hospital offers comprehensive medical care in specialties such as cardiology, cardio-thoracic surgery, neurology, neurosurgery, orthopedics, nephrology, gynecology, gastroenterology, urology, pediatrics, and diabetes.
Gleneagles Global Hospital, Parel, Mumbai
- City: Mumbai, India
Hospital Highlights:
- Gleneagles Global Hospital The 450-bed facility comprises of 17-stories, housing state-of-the-art infrastructure, and advanced medical care facilities.
- The hospital offers end-to-end clinical, surgical, and diagnostic services. It is equipped with a team of eminent medical professionals aided by qualified nurses and medical staff
- The Hospital offers advanced Endoscopic procedures, Hepatobiliary and Liver Surgeries, Surgical and Medical Gastroenterology, Bariatric Surgery, and Robotic surgery.
- The hospital is a center of excellence for Orthopedics, Joint Replacement, Knee Replacement, and Hip Replacement surgery.
Jaypee Hospital, Noida
- City: Noida, India
Hospital Highlights:
- Jaypee Hospital is the flagship hospital of the Jaypee Group.
- This hospital has commissioned 525 beds in the first phase and has been planned and designed as a 1200 bedded multi-specialty facility.
- It holds the accreditation of the NABH and NABL.
- The hospital has state-of-the-art infrastructure equipped with the latest technologies and modern equipment like 64 Slice PET CT, Dual Head 6 Slice SPECT CT, Gamma Camera, and Da Vinci Robotic Surgery for comprehensive robotic surgical solutions.
- It has special Centers dedicated to the major specialties to provide hassle-free and high-quality clinical care.
Manipal Hospital, Dwarka, Delhi
- City: New Delhi, India
Hospital Highlights:
- Manipal Hospitals, Dwarka, is a super-specialty hospital in Dwarka, New Delhi, which is a part of Manipal Hospitals Group.
- The hospital aims to provide the best treatment on par with international standards at a fraction of the cost.
- Equipped with 380 beds, the hospital is also one of the new age hospitals which are equipped fully with state-of-the-art infrastructure, cutting-edge technology as well as the latest and advanced clinical practices. The hospital also has 13 modular Operation theatres with 118 beds which are solely meant for critical care.
- The hospital comprises internationally acclaimed doctors and highly professional and experienced hospital and medical staff who are able to provide preventive, therapeutic, and diagnostic services all under one roof.
WHAT IS AN AVM BRAIN?
What causes Brain AVM?
The primary cause of AVM is still unclear. Some people have brain AVM by birth while some others develop the same later. A notable point is the passing down of this malformation amongst families, genetically.
Occurrence rate of AVMs
Brain AVMs occur very rarely and their occurrence rate is around 1% of the population. However, you might observe male predilection for AVM of the brain.
Where AVMs occur
Although an AVM may develop anywhere within the body, the most common sites are the brain and spine. However, brain AVM is rare and affects only a small chunk of the human population.
Symptoms of Brain AVMs
You may not notice any symptoms of brain AVM till it ruptures. Rupturing of AVM of the brain may result in bleeding within the brain which is termed hemorrhage. A majority of the patients with brain AVM experience hemorrhage as the first sign. Other symptoms of brain AVM include:
- Constant pain in any specific area of the head
- Problems with speech
- Progressive loss of neurological function
- Numbness or paralysis
- Dizziness
- A problem in understanding language
- Nausea and vomiting
- A problem in performing certain tasks that require planning
- Back pain
- Loss of coordination
- Seizures
- Muscle weakness in a specific part of the body
- Loss of consciousness
- Weak lower limbs
- Confusion
- Vision loss
- Serious unsteadiness
- Hallucinations
- Inability to understand what others are saying
- Loss of control on eye movements
- Tingling sensations
Causes of bleeding AVM
The abnormal blood vessels in brain AVM are weak. Hence, they direct blood in a direction against the tissues of the brain. As there is dilation of the abnormal blood vessels with time, they tend to burst. A brain AVM ruptures and bleeds because of the blood flow in a high pressure coming from the arteries.
Chances of AVM bleeding
A brain AVM generally develops between the age of 10 years to 40 years. On average, the chances of bleeding of brain AVM is between 1% to 3% per year. If it bleeds for the first time, the patients are at risk of recurrent bleeding within a short period. Teenagers and the young age group people are at a high risk of experiencing recurrent bleeding.
When to visit the doctor?
If you notice any signs or symptoms of brain AVM, you must visit the doctor immediately. These cases require emergency medical attention otherwise they may bleed profusely & prove to be fatal.
Stages of brain AVM
- Stage 1 of Quiescence: AVM brain malformation is quiet in this stage. The skin surface above the AVM is red and feels a little warm.
- Stage 2 of Expansion: The malformation increases in size to become larger and it is easy to feel the pulse within the malformation.
- Stage 3 of Destruction: The brain AVM begins to bleed and pain.
- Stage 4 of Decompensation: This stage may turn out to be fatal as heart failure occurs in most cases.
Can AVM bleeding prove fatal?
Around 10% to 15% of deaths occur after each AVM brain bleeding. Some patients experience permanent brain damage that accounts for around 30% of the total cases. Every bleed contributes to the damage of normal tissues within the brain that may alter the normal brain functions temporarily or permanently.
Types of Brain AVM
There are 5 different types of brain AVM. These types are listed as under:
- True AVM: This is the most common type of malformation in which the abnormal blood vessels tangle. However, there is no interfering normal tissue of the brain.
- Venous malformation: This malformation involves only the abnormal veins.
- Dural fistula: Dura mater, the covering of the brain, often gets involved in an abnormal connection with the blood vessels. This results in the formation of a dural fistula. There are three types of dural fistulas namely transverse- sigmoid sinus dural fistula, dural carotid-cavernous sinus fistula, and sagittal sinus-scalp dural fistula.
- Cryptic or occult AVM or cavernous malformations: This type of vascular brain malformation doesn’t draw away large quantities of blood. Such malformations may cause seizures and bleed.
- Hemangioma: Abnormal blood vessels at the brain or skin surface are termed hemangioma.
Risk factors of Brain AVM
Males are at a higher risk of developing brain AVM. Apart from this, families with a history of brain AVM have generic passing down of the same.
Complications of Brain AVM
The complications of brain AVM include stroke, speech or movement problems, low quality of life, developmental delays (in children), and numbness in specific parts of the body. Other complications associated may be:
- Weaker blood vessels: An AVM brain exerts pressure on the weaker blood vessels. This may result in an aneurysm or a bulge in the walls of the blood vessels that may rupture later.
- Hemorrhage: AVM causes the walls of the affected veins and arteries to weaken which results in bleeding within the brain or hemorrhage. While hemorrhage goes undetected in some people, some others experience episodes that may be life-threatening.
- Brain damage: In many cases, AVM increases in size to constrict some portions of the brain. Because of this, protective fluids are unable to circulate freely and instead collect at a place. This may cause brain tissue to get pushed against the skull resulting in brain damage.
- Reduced oxygen supply: When brain AVM develops, blood circulates directly to the veins & the arteries. Because of this, surrounding tissues are unable to absorb oxygen from the blood, and these tissues weaken or die.
How Brain AVMs are diagnosed
Your doctor will review all your symptoms and perform a thorough examination. For forming a diagnosis, he or she might ask you to undergo certain tests. These tests are usually performed by neuroradiologists. They are professionally trained to conduct imaging tests for finding the cause and the diagnosis of the condition.
Tests
- CT scan: A Computerized Tomography scan creates a cross-sectional radiographic image of the brain through an x-ray series. Sometimes, doctors perform angiograms which involves injecting a dye. This dye is injected into the veins through a tube so that minute details can be seen.
- Cerebral arteriography: Also called cerebral angiography, it helps to accurately diagnose AVM. It reveals not only the characteristics of arteries that supply AVM and the draining veins but also the exact location. These details are essential for the diagnosis and treatment of the condition. Your doctor will insert a tube called a catheter in the artery of the groin region. He or she will use x-ray imaging to thread it to the brain. Injecting the dye will make the blood vessels clear enough to be seen in the x-ray imaging.
- MRI: Magnetic Resonance Imaging uses radio waves and magnets to obtain precise brain images. This test will provide you with the exact location of AVM within the brain along with any other bleeding spot. Alternatively, your doctor might perform Magnetic Resonance Angiogram using the dye.
Treatment of Aterivenous Malformations (AVMs) of Brain
There are ample treatment options for this malformation. The primary goal is to avoid hemorrhage but it is vital to consider the neurological complications. Your health, gender, age, location, and size of the blood vessels are some critical factors that help in determining the right treatment option.
Stereotactic radiosurgery
This type of treatment involves radiation for the destruction of the brain AVM. To simply put, this isn’t surgery but involves targeting of AVM by the radiation beams. This damages the abnormal blood vessels leaving a scar. The scarred blood vessels clot off within a few years of the treatment. If you have a small AVM that can’t be removed with conventional surgery then your doctor might suggest SRS. People having hemorrhages that may turn fatal also undergo SRS treatment
Endovascular Embolization
It is also called interventional neuroradiology. Your doctor will insert a catheter tube into the artery of your leg and thread it with the brain blood vessels. The catheter is placed in one of the arteries that feed AVM followed by injecting of the embolizing agent. This will block the blood flow to the feeding artery. This is a minimally invasive procedure and is usually done before any surgery. It reduces the chances of AVM bleeding and reduces its size. Endovascular embolization also decreases the chances of stroke-type symptoms.
Surgical removal or resection
If the AVM is bleeding or is located in an easily accessible area of the brain, resection via conventional brain surgery is a preferable treatment option. Your doctor will temporarily remove a portion of your skull to perform resection. AVM can be easily removed with the help of special clips followed by reattachment of the skull bone. Suturing of the incision follows this process to close the scalp region.
Medical therapy
If you aren’t experiencing any symptoms of AVM or the AVM is located in an inaccessible area, you will undergo conservative management. Your doctor will ask you to avoid excess workouts and exercise. Also, you will have to discontinue the intake of blood thinners or anticoagulants like warfarin.
Specialists for brain AVM treatment
A brain AVM treatment is performed by specialists who hold a specialization degree in such cases. They may be:
- A neurosurgeon or radiation therapist who performs stereotactic radiosurgery treatment.
- A stroke neurologist who is proficient in the medical management of such malformations. They can also diagnose easily and perform imaging of the head, neck, and brain region.
- The vascular neurosurgeon can perform surgical removal of AVM of the brain.
- An endovascular neurosurgeon or interventional neuroradiologist who excels in endovascular therapy.
Prevention and prognosis
Most commonly, an AVM occurs by birth or sometime later after the birth of the child. Prevention is difficult as the causes are unknown for a majority of the cases. However, the best thing would be to seek medical attention as soon as you notice the first symptom for a better prognosis. Timely medical treatment always helps in easy management and provides a better quality of life. People who get to know about AVM through bleeding usually die. Some others experience seizures and problems with the nervous system. Many people with undetected AVM till their 50s or 60s experience no symptoms and are stable.
Follow up
You need to visit your doctor regularly for follow-ups after getting surgically operated on for brain AVM. Your doctor might advise you imaging tests again to ensure there is no recurrence and the malformation has resolved completely.
FAQs on Brain AVM
Brain AVM is curable within 2-3 years of treatment. Radiosurgery is often a treatment choice for AVMs that are small in size but in exceptional cases, one may opt for it even for the removal of large AVMs.
One in 2000 people develop brain AVM. A majority of the people live normally with it but they have a risk of bleeding AVM at some time. Sometimes, they may also suffer a stroke due to AVM.
In most cases, AVMs do not rupture. However, there may be recurrent bleeding after it ruptures once.
Most of the asymptomatic AVM cases have a history of bleeding. Due to increased stress, you may have high BP. This may cause the AVM to bleed as the blood will flow at a fast rate and the vessel walls will be weak.
The most important thing to keep in mind is that you must avoid anything that elevates the blood pressure. If you perform a high workout or a strenuous activity, your blood pressure may rise. This will result in strain on your malformation and there are high chances of AVM rupture or bleeding.
AVM is a collection of abnormal blood vessels that restrict blood circulation to the brain. It may sometimes be accompanied by vascular tumors that are surgically removed.
Although there are no cases of passing down of AVM in families, a mere 5% of cases are due to autosomal dominance. However, the causes of AVM are still unknown in a majority of the cases as it is present by birth.
A Grade 4 or Grade 5 AVM is considered a large AVM as it is big and deep within the brain. In most cases, a large AVM is considered to be a risky malformation to be operated upon.
No, AVM hasn’t been identified as a condition of disability but severe complications of its rupture may result in the disability of the person.
No, a brain AVM does not cause any kind of personality changes. However, a patient may experience emotional changes due to the stress of the same.
The warning signs of a brain aneurysm are seizures, headache, nausea, vomiting, loss of consciousness, stiff neck, drooping eyelids, and blur vision.
The symptoms of a brain aneurysm headache are pulsing sensation and throbbing pain. This may last for a couple of hours to a few days and it may be debilitating. The patient might also experience sensitivity to extreme sound and sunlight.
Medical therapy can help you get relief from the symptoms of AVM like headache and pain. You can perform routine activities only after several weeks following the surgery. Most patients require around 4 to 6 months to completely recover from the condition.
There will be a headache suddenly that is severe enough to disturb the patient. The patient will experience headaches in only a specific region of the head with a ringing sound in the ear.
A Cavernoma or a cavernous angioma or a cavernous malformation is one of the types of AVM of the brain. It also contains a collection of weakened blood vessels that block the blood flow.