Patient’s skull opened to treat AVM and multiple Aneurysms

Bangalore, May 12, 2017: 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.

(L-R) Samuel, patient's brother; Dr Deshpande V Rajakumar; Emanuel, the patient 

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

AnAVM is a tangle of abnormal blood vessels which connect arteries and veins. Itdisrupts this process of blood supply to the body carried out by arteries andveins. It is most often seen in brain or spine. The cause for it remainsunknown, but are usually formed later in life. When there is a rupture in AVMit lead to hemorrhage. Thisusually causes no symptoms and often goes unnoticed. Depending on the severityof the hemorrhage, brain damage or death may result.Dr. Deshpande V Rajakumar Director,Neurosurgery, Fortis Hospitals, Bangalore, “During cerebral angiography, the patientwas diagnosed to have multiple Aneurysms with AVM (Arteriovenous Malformation).The size of the AVM was 5.5 centimeter and could keep increasing in size ifleft 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 twoCraniotomies (opening of the skull) with the help of Neuronavigation. To get abetter picture of the AVM during the surgery, a 3D microscope was used.Indocyanine Green (ICG) was injected into the patient to spot the abnormalityduring surgery. The nine-hour surgery was successful and we were able to clipall the aneurysms.” 

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

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


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