AVMs/Aneurysms

AVMs/Aneurysms 2017-12-07T18:51:40+00:00

Blood vessels run throughout the brain providing its necessary oxygen and nutrients. Various abnormalities can develop within the blood vessels in the brain which can limit blood flow and or weaken vessel walls, thereby, putting patients at risk for stroke. Dr. George Bovis is a neurosurgeon who has completed extensive advanced training, called a fellowship, in cerebrovascular neurosurgery. Cerebrovascular neurosurgery is the treatment of the blood vessels within the brain.

This section provides information on Dr. Bovis’ neurosurgical treatment of two of the more prevalent conditions, aneurysms and AVMs, that can develop within the brain’s vascular system.   The stakes are high for appropriate treatment of these conditions. Treating these cases effectively means preventing stroke and even death. Restoring normal blood flow within the brain, and shielding weakened blood vessel sections from the beating they take as a result of normal blood flow are critical steps taken to ensure these patients continue to live, healthy and productive lives. Fellowship-trained neurosurgeons, like Dr. Bovis, are the most appropriate experts to take care of patients with these abnormalities that impact blood flow in the brain.

Dr. Bovis invites you to learn more about the treatment options for aneurysms and AVMs by reviewing the sections below.

Dr. Bovis performs surgery to treat aneurysms and AVMs at Advocate Lutheran General Hospital and Alexian Brothers Medical Center. He also welcomes questions about neurovascular disorders, including aneurysms and AVMs. Prospective patients are welcome to call _____________ to schedule an appointment, or email Dr. Bovis at info@GeorgeBovisMD.com.

AVMs

Arteriovenious malformations, or AVMs, are abnormal tangled webs of blood vessels in the brain. AVMs occur where arterial blood (blood going from the heart to the brain) flows directly into draining veins (blood flow back to the heart). In a normal circulation, arterial blood flows through capillaries, which are very small vessels, only a single cell thick, before entering the draining veins. Capillaries act as a sort of funnel, limiting the amount of blood flowing into the draining veins at one time. Without the capillaries in place, large amounts of blood flow into the draining veins, and cause excessive pressure on them. These veins then stretch to accommodate the additional blood flow, which puts them at risk of rupture.

Many AVMs cause no symptoms.   When symptoms are present, they often occur from bleeding, compression of important structures or areas of the brain, or from irritation to the surrounding brain tissue. Symptoms also depend on the location of the AVM, but commonly include migraine-like headaches and seizures. Additional symptoms caused by brain AVM include:

  • Nausea, vomiting and stiff neck accompanied by a severe headache
  • Bruit (pronounced bruhee) which is an abnormal swishing sound in the ear which is caused by blood flowing through the AVM

Interestingly, AVMs are congenital, which means they are present at birth. The condition is also quite rare, with an estimated 300,000 Americans harboring an AVM. Less than 15% of AVMs cause symptoms, and these usually present when a patient is between 20 and 40 years of age.

It is important to note, that just because an AVM doesn’t cause symptoms, doesn’t mean it shouldn’t be treated. When Dr. Bovis sees a patient with a brain AVM that has been identified as an incidental finding, he discusses the pros and cons of treatment, including the risk of rupture of the AVM. Risk of rupture is determined after considering many factors, including the size, location, type and involvement with other structures, as well as the patient’s age.

Similar to aneurysms, if an AVM ruptures and bleeds into the brain, significant disability and even death is a risk. The first time an AVM ruptures, the patient has a 10 to 30% risk of death, and subsequent ruptures are significantly more common after the first.

Dr. Bovis will consider four treatment options for the treatment of an AVM

  1. Observation
  2. Surgery
  3. Gamma Knife radiosurgery
  4. Endovascular embolization

Treatment of an AVM is a complex process. Dr. George Bovis is a neurosurgeon that completed additional and advanced training, called a fellowship, in treating cerebrovascular disorders. Treatment of patients with cerebrovascular disorders, including AVMs, are among the most challenging situations faced by neurosurgeons today. Fellowship-trained neurosurgeons, like Dr. Bovis, have more experience effectively managing these complex conditions.

In order to definitely diagnose an AVM and garner the necessary information to develop an individualized treatment plan, Dr. Bovis will thoroughly evaluate your physical condition and ascertain your family history. In addition, Dr. Bovis may order imaging studies to help ascertain the exact location, size, type and complicating structures of the AVM. These studies may include a CT or MRI scan or a diagnostic angiogram.

Once Dr. Bovis studies the images and information provided from the diagnostic work-up he will discuss three treatment options with his patients who have a confirmed brain AVM. In some cases observation may be the best course of treatment.

In those cases where Dr. Bovis recommends an intervention, conventional open surgery as well as Gamma Knife stereotactic radiosurgery will be discussed, either as two separate treatments, or as complementary options.

The surgical treatment for an AVM involves performing a craniotomy (removing a section of the skull) to access the brain to reach the site of the AVM. At that time, Dr. Bovis will use highly precise and sophisticated laser and cauterizing instruments to remove the AVM from the normal brain tissue. Dr. Bovis will also use advanced imaging technologies, including intraoperative MRI and surgical navigation software, to provide as much visualization and information about the AVM as possible. Dr. Bovis’ extensive experience in surgically removing AVMs also assures patients they have entrusted their care to an excellent neurosurgeon.

Another option for patients with an AVM where treatment is recommended, is Gamma Knife radiosurgery. Gamma Knife radiosurgery is a non-invasive procedure which uses cobalt radiation to obliterate a brain lesion. It is highly precise and impacts only the lesion while preserving the healthy brain tissue surrounding the tumor. Dr. Bovis is one of the leaders in the country using this approach to treat brain tumors and other conditions, like AVMs.

When the vessels of the AVM are blasted with a highly concentrated dose of radiation delivered by the Gamma Knife, they begin to gradually close off and turn into scar tissue. This process takes between six months and two years. Once the vessels “dry up”, the risk of rupture is gone.

In addition to using the surgical and radiosurgical approaches to the treatment of brain AVMs on a stand alone basis, Dr. Bovis also uses them in combination for more complex situations. One of the risks of the open surgical removal of the AVM is the risk that the AVM will bleed during the procedure, and cause harm to surrounding tissues. In order to minimize this risk, Dr. Bovis may use Gamma Knife radiosurgery first, to begin limiting blood flow through the vessels of the AVM. With the reduced blood flow, comes a reduced risk the AVM will bleed during surgery. By staging the AVM treatment approach, Dr. Bovis can more safely remove the AVM with open surgery.

Dr. Bovis may also refer patients to an interventional radiologist or neurosurgeon for consideration of treating the AVM through endovascular embolization.   The final recommended treatment plan will be developed by Dr. Bovis and discussed with the patient, and will take into consideration many factors, including the age and overall health of the patient, as well as the size, location, and overall blood flow through the AVM and overall in the brain.

Dr. Bovis performs surgery to treat AVMs at Advocate Lutheran General Hospital and Alexian Brothers Medical Center. He also welcomes questions about AVMs. Prospective patients are welcome to call _____________ to schedule an appointment, or email Dr. Bovis at info@GeorgeBovisMD.com.

Aneurysms

Cerebral aneurysms, or aneurysms formed in the brain, are found in 2 to 5% of the general population. Although the number of affected patients isn’t huge, the consequences, if an aneurysm ruptures, can be devastating. Because many aneurysms cause no symptoms, they are frequently not diagnosed, until they rupture. Once an aneurysm ruptures, however, the chance of survival significantly diminishes. It is estimated that more than 30,000 aneurysms rupture each year in the United States. Roughly one-third of these patients do not survive long enough to reach the hospital. Of the patients who do receive appropriate medical treatment, approximately 60% will have a good recovery. The remaining patients are either severely disabled or die due to extenuating complications.

The appropriate treatment, therefore, for unruptured aneurysms detected incidentally, or because of some subtle symptoms is critical. Dr. George Bovis, neurosurgeon at Lutheran General Hospital and Alexian Brothers Medical Center, has gone through extensive and advanced training, called a fellowship, to treat patients with vascular conditions in the brain, like aneurysms. When aneurysms are treated before they rupture, the long-term clinical results are excellent.

Patients with a confirmed or suspected aneurysm will be thoroughly evaluated by Dr. Bovis. A full patient history and physical exam will be performed. Imaging studies, possibly including an angiogram, may be performed to provide Dr. Bovis an exact picture of the size, shape and location of the aneurysm, as well as the blood vessels running through and in the vicinity of the aneurysm. All of this information is critical to planning a successful treatment.

There are essentially three options for the treatment of aneurysms:

  1. Observation
  2. Surgical clipping
  3. Endovascular coiling

In some cases, where an aneurysm is small and not causing symptoms, Dr. Bovis will recommend ongoing observation rather than invasive treatment.

In other cases, however, where given the size and location of the aneurysm, the risk of rupture is too great, Dr. Bovis may recommend open surgery. He will perform a craniotomy (removal of a flap of the skull), and “clip” the aneurysm. During this procedure, Dr. Bovis navigates to the location in the brain of the aneurysm and places a surgical clip across the neck of the aneurysm, thereby redirecting blood flow out of the body of the aneurysm and restoring normal flow through the impacted blood vessel.

Today’s surgery for aneurysm clipping is much different than it was a few years ago. Advancements in intraoperative imaging technologies, including the intraoperative MRI scan used by Dr. Bovis, as well as improved clip designs, and innovative approaches, facilitated by sophisticated navigation software, have made the surgical treatment of aneurysms safer and less disruptive to normal brain tissue.

The surgical treatment of aneurysms performed by Dr. Bovis is well-studied and excellent long-term results, over several decades, have been published in the literature.

Dr. Bovis may also refer patients to an interventional radiologist or neurosurgeon for consideration of coiling the aneurysm.   The final recommended treatment plan will be developed by Dr. Bovis and discussed with the patient, and will take into consideration many factors, including the age and overall health of the patient, as well as the size, location, and shape of the aneurysm.

Dr. Bovis performs surgery to treat aneurysms at Advocate Lutheran General Hospital and Alexian Brothers Medical Center. He also welcomes questions about brain aneurysms. Prospective patients are welcome to call _____________ to schedule an appointment, or email Dr. Bovis at info@GeorgeBovisMD.com.