Patient’s skull opened to treat AVM and multiple Aneurysms

33-year-old patient was admitted at Fortis Hospitals, Bannerghatta Road with complaint of persistent headache and diagnosed with multiple weak and bleeding blood vessels under his skull.

The patient was suffering from Arteriovenous Malformation (AVM) -- tangle of abnormal and poorly formed blood vessels -- which led to hemorrhage. Daunted by the complexity of his condition Emanuel came to India from Ghana, Africa, to get the rare condition treated. During the operation, the doctors clipped the aneurysms and excised AVM to prevent further bleeding. The condition was so complex that any bleeding during his travel to India or on the operation table, could have led to a stroke or death.

An AVM is a tangle of abnormal blood vessels which connect arteries and veins. It disrupts this process of blood supply to the body carried out by arteries and veins. It is most often seen in brain or spine. The cause for it remains unknown, but are usually formed later in life. When there is a rupture in AVM it lead to hemorrhage. This usually causes no symptoms and often goes unnoticed. Depending on the severity of the hemorrhage, brain damage or death may result.

Dr. Deshpande V Rajakumar Director, Neurosurgery, Fortis Hospitals, Bangalore, “During cerebral angiography, the patient was diagnosed to have multiple Aneurysms with AVM (Arteriovenous Malformation). The size of the AVM was 5.5 centimeter and could keep increasing in size if left unattended. We started the treatment process with MRI and Brain Angiogram. The AVM along with other Aneurysms were present far from each other under the skull. Because of the distance between the Aneurysms, we had to conduct two Craniotomies (opening of the skull) with the help of Neuronavigation. To get a better picture of the AVM during the surgery, a 3D microscope was used. Indocyanine Green (ICG) was injected into the patient to spot the abnormality during surgery. The nine-hour surgery was successful and we were able to clip all the aneurysms.”

Dr Murali Krishna, Consultant, Neuro Surgeon, Fortis Hospitals, Bangalore, explaining the atypical case says that, “Back in Ghana, Emanuel suffered partial paralysis attack in 2012 after he had a brain hemorrhage. He was given a symptomatic treatment through which he slowly recovered. But the last three months, he suffered from severe headache and was admitted at our hospital for further diagnosis.”

Post-surgery, Emanuel informed that he had persistent headache for three months which got severe with every passing day. “However, when I suffered paralysis, I got to know what it was exactly. As I was not able to tolerate the headache anymore, I decided to get it treated. I had heard about Fortis Hospital and decided to get admitted here. The doctors were supportive and understood my condition well and treated accordingly”.

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