Neurosurgery for the Cologne area explains things
COLOGNE AREA. The number of diagnoses of angioma, medically known as arteriovenous malformation (AVM), is increasing. While it was considered a rare disease in the past, it is now diagnosed more frequently thanks to modern imaging techniques. “An angioma is a type of short circuit between arteries and veins in the brain,” explains Prof. Dr. med. Veit Braun, head of neurosurgery at the Diakonie Klinikum Jung-Stilling in Siegen. Patients from the greater Cologne area with angioma are also treated and cared for here.
An angioma is a congenital tangle of blood vessels that usually lacks a muscle layer and is therefore very thin. The risk of them bursting is relatively high. An angioma often remains inconspicuous for years. However, they can cause a cerebral hemorrhage or epileptic seizures. This causes blood to be withdrawn from the surrounding brain, which is known as the steal phenomenon. Bleeding is a life-threatening event. Younger patients or women in the final stages of pregnancy are often affected by a noticeable angioma.
Angioma diagnosis – what now? Answers from neurosurgery for the Cologne catchment area
How common is an angioma diagnosed? There are currently around 1,100 initial diagnoses in Germany. Around 400 malformations are noticeable due to bleeding. Around 700 angiomas are discovered using imaging techniques as part of a headache or epilepsy diagnosis. Angiography is primarily used as the diagnostic standard. “If an angioma is diagnosed, the question arises as to whether headaches or seizures are actually due to the arteriovenous malformation and, of course, how high the risk of bleeding is,” says Prof. Dr. med. Veit Braun. About one in 100 patients with angioma will experience bleeding. This probability must be taken into account in the risk assessment and treatment decision. An operation also poses a significant risk. And this risk significantly exceeds the risk of an angioma rupturing. In around ten percent of angioma patients treated neurosurgically, neurological symptoms remain after the operation. The following therapeutic procedures come into question:
– Endovascular Embolization
– Neurosurgical removal
– Stereotactic Radiotherapy.
Psychologically stabilize patients with unruptured angioma in the Cologne area
Neurosurgeon Prof. Dr. med. Veit Braun points out that the risk of therapy is out of all proportion to the benefit, especially in the case of large angiomas. In particular, the risk of patients developing hemiplegia after surgery outweighs the risk of spontaneous bleeding from the angioma.
This experience is also confirmed by an international study entitled “Medical management with interventional therapy versus medical management alone for unruptured brain arteriovenous malformations (ARUBA): final follow-up of a multicentre, non-blinded, randomized controlled trial” (1). was published in the specialist magazine “The Lancet”. The study related to the ARUBA long-term study, which was conducted at 39 clinical centers in nine countries. Included in ARUBA were adults older than 18 years who were diagnosed with an unruptured cerebral arteriovenous malformation, had never undergone interventional therapy, and were considered suitable for angioma eradication intervention by participating clinical centers.
The ARUBA study came to the conclusion that drug treatment alone (for neurological disorders such as seizures) is superior to the combination of conservative (drug) treatment and interventional therapy (surgery, embolization, radiation in any combination) in preventing symptomatic strokes or death was superior. But does this also apply over a longer period of time? The researchers led by Prof. J. Mohr investigated this question. After an extended follow-up period, their data confirmed that drug treatment alone was still superior to interventional therapy in terms of the risk of death or stroke in patients with an unruptured arteriovenous malformation in the brain.
The current guidelines for the treatment of angiomas even speak of a high risk of interventional therapy. “Even if the transferability of the results from the ARUBA study continues to be controversial, it clearly shows that in any case the indication for invasive therapy must be carried out after a careful benefit-risk analysis and in an interdisciplinary manner,” says Prof. Dr. med. Veit Braun out. The guideline recommends that patients diagnosed with a cerebral AVM should go to hospital. A facility in which neurosurgeons, neuroradiologists and radiation therapists, as well as neurologists, are familiar with the clinical picture and pursue interdisciplinary treatment concepts. These requirements can be found at the Diakonie Klinikum Jung-Stilling in Siegen.
If the decision is made against surgery, psychological stabilization of the patient is important. Knowing about an angioma can be very unsettling for those affected. Nevertheless: “Patients with angioma are not restricted in everyday life and do not have to hold back on physical activities. Because physical stress does not increase the risk of the angioma rupturing,” points out Prof. Braun.
(1): Mohr, Jay P.; Overbey, Jessica R.; Hartmann, Andreas et. al.: Medical management with interventional therapy versus medical management alone for unruptured brain arteriovenous malformations (ARUBA): final follow-up of a multicentre, non-blinded, randomised controlled trial. In: The Lancet Neurology, July 2020.
Professor Dr. med. Veit Braun is head of neurosurgery at the Diakonie Klinikum Jung-Stilling in Siegen. Head operations such as brain tumors, aneurysms, angiomas or Jannetta are carried out in state-of-the-art operating rooms with 3D image converters, neuronavigation, fluorescence and neuromonitoring. The entire spectrum of modern neurosurgery is offered. The medical team in the neurosurgical department within the clinic consists of 13 employees, 6 of whom are specialists in neurosurgery.
Contact
Diakonie Klinikum Jung-Stilling Hospital Neurosurgical Clinic
Prof. Dr. med. Veit Braun
Wichernstrasse 40
57074 wins
02 71 3 33-43 82 or -42 21