Treatment

There are several treatment modalities used to manage AVMs: (1) microsurgical excision, (2) endovascular embolization, (3) stereotactic radiosurgery or (4) a combination of these various modalities. The management of a patient with an AVM is best accomplished at specialized neurovascular referral centers where there is a multidisciplinary team, including neurosurgeons, interventional neuroradiologists, radiation therapists, neuroanesthesiologists and neurointensivists. For example, the pre-operative use of endovascular embolization may improve the probability and safety of complete microsurgical resection or make an AVM amenable to stereotactic radiosurgical cure. This combined multimodality approach may significantly reduce the risk of AVM treatment and improve outcome.

Several factors influence whether or how an AVM should be treated: (1) patient age and clinical condition, (2) presentation, (3) AVM location, size, morphology and complexity and (4) expected natural history and treatment risks.

Management needs to be individualized to each patient and requires careful study of all radio-logic images, including CT, MRI and detailed cerebral angiography. Some patients may also require functional imaging studies such as fMRI, MEG or PET scanning to localize eloquent cortex, because several studies have demonstrated that anatomical landmarks to localize eloquent cortex may be imprecise and that these areas may be subject to variability among patients. Alternatively, hemispheric dominance for speech or language can be established by intracarotid sodium amobarbital (Amytal) injection (WADA test). In addition, superselec-tive angiography with amytal injection can establish whether an area of brain supplied by a particular artery is eloquent and so should be preserved. This information may influence whether surgery is selected and influence the use of intraoperative mapping techniques.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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