An innovative method for closing arteriovenous malformations (AVM) in the brain using a balloon has been performed for the first time in Israel at Jerusalem’s Shaare Zedek Medical Center.

An AVM is a congenital tangle of abnormal and poorly formed arteries and veins that have a higher risk of bleeding than normal vessels. AVMs can occur anywhere in the body, but AVMs in the brain are of special concern because of the damage they cause when they bleed.

In the case of a cerebral AVM, the blood vessels dilate and tiny spaghetti-shaped shunts develop into a knot which can cause severe complications, including the halt of oxygen-supply to the brain, brain hemorrhages and electrical “shorts.”

This new method of treatment for the ailment has been introduced to the world in recent months, enabling safer and more focused treatment of AVMs. Now, the first three Israeli patients have been treated successfully by Dr. Ya’acov Amsalem, director of interventional neuroradiology at Shaare Zedek.

“To promote oxygen supply to the brain and prevent brain damage, the diseased blood vessels must be closed,” Amsalem said. “Since this is a network of blood vessels that are difficult to control, many surgeries in the past would have ended with disability and [therefore] did not justify treating the problem… In many cases, it was found that the risk outweighed the benefit.”

Since then, a number of technologies have been developed that allow for more accurate treatment by catheterization – the use of micro-catheters that allow easy access to very tiny blood vessels which was introduced about a decade ago. In addition, liquid embolic agents that are like glue, but flexible and do not dry quickly, were invented that can be used with the micro-catheter.

The new method utilized at Shaare Zedek involves the closure of veins through the use of a tiny balloon introduced on the tip of a tiny catheter, which prevents leakage. The glue is slowly injected, eliminating the swelling and malformation in the diseased blood vessels that would otherwise cause brain hemorrhage. The blood supply then gradually returns to the brain area that had suffered from a lack of oxygen supply.

One case of treatment involved a 20-year-old soldier who collapsed during a military operation and had a seizure. He was taken to a hospital in the south of the country, underwent a CT scan that showed something that looked like a tumor. He was transferred to Shaare Zedek, where he was found to actually be suffering from cerebral AVM. After undergoing the treatment, he woke up without any neurological deficits and was sent home completely well after just two days of hospitalization.

“There is no doubt that the catheterization approach significantly reduces the risks and complications associated with these surgeries and ensures that oxygen returns to the brain gradually and safely,” Amsalem said.


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