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Treating Patients with Vascular Formations

In This Video

  • About 5% to 6% of patients in the world have vascular malformations around their brain and spine
  • Brain imaging is one important multidisciplinary pathway of managing and evaluating vascular formations
  • Here, James Rabinov, MD, discusses how brain imaging can lead to high treatment and cure rates with low rates of complications
  • He emphasizes the importance of longitudinally following patients to make sure that they are doing well

Approximately 5% to 6% of patients in the world have vascular malformations around their brain and spine. Brain imaging is one of the multidisciplinary pathways of managing and evaluating patient conditions. it is especially important for patients who had seizure-related outcomes due to their vascular malformations. In this video, Massachusetts General Hospital Neurosurgeon James Rabinov, MD, discusses how brain imaging can lead to high treatment and cure rates with low rates of complications. He also emphasizes the importance of following patients longitudinally to ensure that they do well neurologically.

Transcript

About 5% to 6% of patients in the world have vascular malformations around their brain and spine. And those can come in two variations. One are arteriovenous (AV) malformations in the parenchyma of the brain or spinal cord, and the others are vascular malformations in the coverings, or the dural membranes around the brain and spine.

Among the multi-disciplinary avenues of management and evaluation for patients, includes sophisticated brain imaging. Looking at the flow rates through their AV malformations (AVM), it can include looking for areas of hemorrhage with sophisticated susceptibility-weighted type of imaging. It also looks at the white matter tracts which are adjacent to an AVM, including looking at diffusion tensor abnormalities in the white matter tracts. These are very important for patients who have seizure activities related to their vascular malformations.

A great study called the ARUBA Trial was done in a randomized fashion around the world, to look at patients who had arteriovenous malformations inside the brain itself. That trial interestingly showed that medical therapy was safer and better for patients. However, that was not our clinical experience here at Massachusetts General Hospital.

What we found is that the treatment rates and cure rates were high and also the complications or challenging situations that patients can evolve into, were equal to that of natural history. So, in essence, we have a treatment rate that works well for patients, and yet the complications are very low, similar to that in the natural history of patients. So that will stand as a counterpoint to the ARUBA Trial.

And finally we have a longitudinal way of following our patients with our multi-disciplinary groups at the hospital. That allows us to evaluate patients up-front. It allows us to do iterative evaluation between stages of treatment, whether that happens to be endovascular embolization or surgery, or radio-surgery.

And then finally, we follow our patients longitudinally to make sure that they are neurologically doing as well as possible and also for any evidence of recurrence of patients with their vascular malformations, or development of other diseases.

Learn more about the Cerebrovascular Program at Mass General

Refer a patient to the Department of Neurosurgery

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