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BERNARD BENDOK: Here at Mayo Clinic we have an AVM conference where we talk about AVMs as a group. And we try to focus the care amongst a small group of individuals who have developed tremendous expertise. Our radiologists, for example, are extremely experienced with picking up subtle signs of hemorrhage on an MRI or a CAT scan and then looking for subtle signs of an AVM on a scan that may not be obvious on a superficial review.
HARRY CLOFT: It's a very characteristic appearance in an AVM where there's a tangle of blood vessels there that shouldn't be there.
BERNARD BENDOK: The combination of CT angiography with advanced MR techniques, they are going to look at the structure of the brain, the structure of the AVM, and even the function of the brain tissue around the AVM.
KELLY FLEMMING: Then a multidisciplinary team would look at that angiogram and make decisions about what is the best treatment.
PAUL LINDELL: The treatment of AVMs has gone from a primarily surgical approach to a combined endovascular approach.
HARRY CLOFT: Usually it's open surgery or radiosurgery that ultimately cures the AVM, but sometimes blocking off some of the blood supply through a catheter can help those procedures be safer and more effective.
BERNARD BENDOK: When a patient presents with hemorrhage it's very important to have a very advanced critical care team that can manage the patient medically to reduce brain pressure, and in some cases, we can go in and seal the rupture site with glue or coils. And then we bring the patient back down the road, once they've recovered, to definitively treat the AVM. And that requires the expertise of a neurosurgeon, a vascular neurologist, a radiation oncologist who all specialize in treating AVMs.
We've recently added augmented and virtual reality to our platform so that we can study our AVMs in three dimensions using 3D prints, but also virtual reality platforms. And then we take that data set, that knowledge that we've gained, so we can, together with our teams, our nurses and technicians, rehearse the operation. So there are no surprises or we minimize the chance for a surprise. Because we can simulate things that can go wrong to make us better practitioners.
HARRY CLOFT: We continue to get a lot of patients referred to us. That provides us with continuing evolution of experience so that we can come up with good diagnoses and therapies. And also the basic principle that we have of the patient comes first and offering compassion, I think is extremely important.
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