Dr. Carlos A. Noreña Osterroth — Neurocirujano en Tijuana ES Book a visit
Brain AVM surgery in Tijuana — Dr. Carlos A. Noreña Osterroth
  1. Home
  2. Procedures
  3. Brain AVM surgery in Tijuana

Brain AVM surgery in Tijuana

An AVM is a tangle of vessels where arteries drain directly into veins with no capillaries in between. It bleeds, causes seizures, or steals flow from neighbouring tissue.

What it is and why it causes trouble

In a normal brain, blood passes from arteries through capillaries to veins, which receive it at low pressure. In an arteriovenous malformation that intermediate step does not exist: arterial blood enters, at high pressure, veins that were never built for it. Over years those veins dilate and weaken.

Hence the three ways an AVM shows itself: intracerebral haemorrhage, which is the most serious; seizures from irritation of the neighbouring cortex; and progressive deficit from flow steal. Many are discovered after a first seizure, in young and otherwise healthy patients.

Three treatments that are often combined

Microsurgical resection removes the whole nidus and is the only option that abolishes bleeding risk immediately. Endovascular embolisation occludes arterial feeders and is often used before surgery to reduce flow and make it safer. Stereotactic radiosurgery gradually closes small deep malformations, but takes two to three years to work.

The decision is made with the angiogram and the Spetzler-Martin scale, which weighs size, venous drainage and whether the AVM lies in eloquent cortex. A small superficial malformation in a non-eloquent lobe is a clear surgical case; a large deep one beside the thalamus often is not. Saying so plainly is part of the treatment.

What the procedure involves

Cerebral angiographyDefines feeders, nidus and venous drainage — the facts that set the strategy.
Risk gradingThe Spetzler-Martin scale weighs size, eloquence and deep drainage before surgery is offered.
Pre-operative embolisationCoordination with endovascular therapy to reduce nidal flow before resection.
Circumferential microsurgical resectionArterial feeders are occluded first and the draining vein last; reversing that order is catastrophic.
Radiosurgical alternativeFor small deep malformations where open surgery would carry a high functional cost.

When it is indicated

  • Intracerebral haemorrhage from AVM rupture
  • AVM with poorly controlled seizures
  • Superficial AVM in non-eloquent cortex with a favourable surgical grade
  • Malformation with an associated flow-related aneurysm
  • Progressive neurological deficit attributable to flow steal
  • Persistent headache with a documented AVM and nidal growth

Techniques and resources

  • Operating microscope
  • Cerebral angiography
  • Clips and bipolar coagulation
  • Pre-operative embolisation
  • Stereotactic radiosurgery
  • Neurophysiological monitoring

Frequently asked questions about arteriovenous malformation surgery

No. Some — especially large, deep ones in eloquent areas — carry a surgical risk greater than their annual bleeding risk. In those, radiosurgery, combined treatment, or observation with blood pressure and seizure control is chosen instead.

The annual haemorrhage risk of an untreated AVM is low but cumulative, and rises if it has bled before, if it has deep venous drainage, or if it carries an associated aneurysm. That calculation is exactly what is weighed against the risk of treatment.

They often improve substantially once the malformation is gone, but they do not always disappear or allow anti-epileptic medication to be stopped straight away. Seizure management is carried jointly with neurology.

Neurosurgical consultation

Bring your imaging and settle the question

One consultation with your MRI or CT in hand is worth more than ten internet searches. Book by phone or through the form and you will be told what is there, what it means and what your options are.

Book a visit Call