Materiały źródłowe

• #1 CE Activity | Arteriovenous Malformation of the Brain | Nurses

  https://www.statpearls.com/nurse/ce/activity/38804

  Arteriovenous malformations (AVMs) are a developmental anomaly of the vascular system, consisting of tangles of poorly formed blood vessels in which the feeding arteries are directly connected to a venous drainage network without any interposed capillary system. AVMs can occur anywhere in the body, however, brain AVMs are of special concern because of the inherent high risk of bleeding of the abnormal blood vessels that can cause neurological damage. This activity reviews the pathophysiology, presentation, and highlights the role of the interprofessional team in the management of these patients. […] This activity has been designed to meet the educational needs of physicians, physician associates, nurses, pharmacists, and nurse practitioners. […] At the conclusion of this activity, the learner will be better able to:

• #2 Arteriovenous Malformation (AVM) » Lillian S. Wells Department of Neurosurgery at the University of Florida » College of Medicine » University of Florida

  https://neurosurgery.ufl.edu/patient-care/diseases-conditions/arteriovenous-malformation-avm/

  Brain arteriovenous malformation (AVM) is an abnormal tangle of blood vessels in the brain which can cause bleeding in the brain, seizures, or stroke-like symptoms (weakness, numbness, tingling). […] Brain AVMs can bleed in the brain in which case patients may have a severe headache, nausea and vomiting, blurred vision, stiff neck, or loss of consciousness. […] The treatment of a brain AVM is either by surgery (opening the skull and surgically removing the AVM from the brain), embolization (injecting substances into the AVM to block off the abnormal vessels via tiny plastic tubes inserted in the patients groin and navigated to the brain by x-ray guidance and not requiring surgery), or radiosurgery (a one-time treatment of high-focused radiation to the brain AVM). […] Brain AVMs are either treated after they have caused bleeding, or in some patients, an AVM is found before it has bled, and is treated to prevent it from bleeding.

• #3

  https://www.eehealth.org/services/neuro/services-and-specialties/avms/

  AVMs „short circuit” the system by interfering with the capillary mesh that usually exists between arteries and veins. […] Following the embolization procedure, you will be transported to the Neuro Intensive Care Unit (ICU) for one to two days of close monitoring. Nurses in the Neuro ICU will perform neuro assessments, check your vital signs, and administer medications and treatments to promote your recovery. […] Following craniotomy for removal of the AVM, you will be transported to the Neuro ICU for close monitoring and comprehensive care. The typical hospital length of stay is 7-12 days. […] Edward-Elmhurst provides integrated care from a team of neurologists, neurointerventional surgeons, neurosurgeons, skilled critical care nurses and rehabilitation therapists to help you regain strength, maximize functioning, and put you on the road to recovery.

• #4 Living With Arteriovenous Malformation | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-malformation/survival/living-with-arteriovenous-malformation

  Those living with AVM must understand the potential risks associated with their condition and take steps to manage and prevent them. […] Although the chances are slim, the following are the possible complications of the condition: Hemorrhage: People living with AVM are at risk of hemorrhage. This is because the high-pressure arterial blood flow directly into the veins can make the walls of the affected blood vessels weaker and more prone to rupture. Hemorrhages can have severe consequences, including stroke, neurological damage or even death. […] AVM surgery is one of the most challenging operations in neurosurgery. The operation comes with potential risks, and it is not always possible to remove the AVM completely. […] While living with an AVM can be very difficult, knowing that you are not alone is important. Finding individuals who understand what you are going through because they have gone through similar experiences themselves can be reassuring and extremely helpful.

• #5 Cerebral Arteriovenous Malformation AVM

  https://www.rch.org.au/kidsinfo/fact_sheets/Cerebral_Arteriovenous_Malformation_AVM/

  A Cerebral Arteriovenous Malformation (AVM) is a collection of tightly tangled, abnormal looking, and enlarged blood vessels. AVMs are abnormal and complex connections between arteries and veins which interfere with the circulation of blood. As a result, some AVMs can burst and cause bleeding into or around the brain, which is also known as a haemorrhagic stroke. A haemorrhagic stroke is a medical emergency and requires immediate treatment. […] Your child’s treatment will depend on their own situation. However, a bleeding AVM in the brain (haemorrhagic stroke) is a medical emergency and requires immediate attention. The AVM may also require a combination of treatments. […] The goal of emergency treatment is to prevent further complications by limiting bleeding, controlling the pressure of suddenly expanding blood on the brain tissue, controlling seizures (if any) and, if possible, removing the AVM.

• #6 Brain AVM (arteriovenous malformation) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/brain-avm/diagnosis-treatment/drc-20350265

  Our caring team of Mayo Clinic experts can help you with your brain avm (arteriovenous malformation)-related health concerns […] The main goal of treatment is to prevent bleeding, known as a hemorrhage. Treatment also can help control seizures or other brain symptoms. […] Sometimes healthcare professionals decide to monitor a brain AVM rather than treating it. This may be recommended if you have few or no symptoms or if your AVM is in an area of your brain that’s hard to treat. Monitoring includes regular medical checkups with your healthcare team. […] You can take steps to cope with the emotions that may come with a diagnosis of brain arteriovenous malformation (AVM) and the recovery process. Consider trying to: Learn about brain AVM to make informed decisions about your care. […] Ask your healthcare professional about support groups in your area. You also might look online or check the library. You may find a support group through a national organization, such as the American Stroke Association or the Aneurysm and AVM Foundation. […] Avoid any activity that may raise your blood pressure and put stress on a brain AVM, such as heavy lifting or straining. Also avoid taking any blood-thinning medicines, such as warfarin (Jantovin).

• #7 Arteriovenous Malformation (AVM) Nursing Management – RNpedia

  https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/arteriovenous-malformation-avm/

  Ineffective tissue perfusion: Cerebral related to shunting of blood from cerebral tissue and/ or intracerebral hemorrhage (ICH). […] Monitor ECG continuously because hypoxemia and cerebral bleeding are risk factors for pronounced ST segment and T-wave changes and life-threatening dysrhythmias. […] Monitor ICP, analyze the ICP waveform, and calculate CPP every hour. […] Monitor BP and pulse every 15 to 30 minutes initially, then hourly. […] Assess pain using the patients self-report whenever possible. […] Note headache onset and severity; presence of stiff neck; and insidious onset of confusion, disorientation, decline in consciousness, and/or focal deficits (weakness of extremity). […] Assess neurologic status using Glascow Coma scale and assess for changes suggesting increased ICP and herniation.

• #8 Arteriovenous Malformation (AVM) Nursing Management – RNpedia

  https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/arteriovenous-malformation-avm/

  Be alert for subtle changes and new focal deficits. […] Assess for factors that can cause increased ICP, evaluate the patient for restlessness, distended bladder, constipation, hypovolemia, headache, fear, or anxiety. […] Maintain patent airway and administer oxygen as ordered to prevent hypoxemia. […] Institute measures to minimize external stimuli and maintain BP level. […] Administer antihypertensive drugs as ordered. To control blood pressure. […] Sedatives and stool softeners may be prescribed to reduce agitation and straining. […] Anticipate interventions such as embolization, resection, clipping, ligation of feeding vessels, proton-beam therapy, or gamma radiation.

• #9 Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery: a prospective single-center study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8088033/

  We sought to explore an optimal clinical nursing mode following a hybrid surgery for cerebral arteriovenous malformation. […] The poor postoperative state of these patients results in an increased nursing difficulty, so it is necessary to improve the level of nursing care, to enhance patients and their families knowledge and understanding of disease, and to help patients through the postoperative risk period. […] Intensive postoperative nursing can improve the safety of patients after hybrid surgery, reduce the postoperative complications and the average length of hospital stay, and improve the quality of life of patients. […] The treatment goal of hybrid surgery is to remove the foci and improve the neurological function, while the goal of nursing is to prevent complications and improve patients psychological health and understanding of postoperative conditions, thereby improve the quality of life of patients, and reduce the length and the cost of the hospital stay.

• #10 Living With Arteriovenous Malformation | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-malformation/survival/living-with-arteriovenous-malformation

  The diagnosis of a brain arteriovenous malformation (AVM) can be a lot to take in. This is especially true if the AVM has ruptured and caused serious neurological consequences. […] Fortunately, treatment options and rehabilitation programs are available to manage the AVM and help you to adapt to your new life. Below, we will discuss living with an AVM and the different types of therapies available. […] If you have been diagnosed with an AVM, the thought of its possible rupture into the brain can be frightening. […] Rest assured, however, as currently there are treatment options available to prevent the rupture and cure the AVM in many cases. While living with an AVM, these are some things you can do to manage your condition: Stay on top of your medical care. This means attending all appointments and taking any medications prescribed by your doctor. Learn as much as you can about your condition. This will help you to be an active participant in your care and make informed decisions about your treatment. Take care of yourself physically and emotionally. It can be surprising how much a healthy diet and regular exercise can help you manage stress.

• #11 Arteriovenous Malformation (AVM) Treatment & Surgery | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/neurosurgery/arteriovenous-malformations-treatment

  The advantage is that the AVM is then considered cured. […] Stereotactic Radiosurgery uses highly focused radiation that targets and intentionally damages blood vessels of the AVM. […] Advanced surgical techniques for AVM repair can bring life-changing results for someone living with an AVM. […] Before your AVM treatment, the BWH neurosurgery team will detail what you can expect both before the day of treatment and following the treatment. […] For those undergoing AVM surgery, embolization or sclerotherapy may be done before surgery to reduce the impact or risk of surgery. […] During AVM surgery, a patient will be under general anesthesia. […] Possible AVM surgery side effects include: Stroke or seizure, Numbness or slow movement, Problems with speech or memory, Small risk of hemorrhage.

• #12 Arteriovenous Malformation (AVM) Treatment & Surgery | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/neurosurgery/arteriovenous-malformations-treatment

  The recovery from AVM surgery begins immediately following the procedure. […] Your doctor will work with you on when to restart any medications and if any new medications may be needed. […] The Center for Cerebrovascular Diseases is home to a team of neurosurgeons among them world leaders in the treatment of AVMs. […] We understand that confronting an AVM can be frightening for many patients and families; our guiding principle is to put the patient and family first.

• #13 Arteriovenous Malformations Diagnosis and Symptoms | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/neurosurgery/arteriovenous-malformations

  The Department of Neurosurgery at Brigham and Womens Hospital provides compassionate, patient-centered diagnosis and comprehensive treatment of brain and spinal Arteriovenous Malformations (AVMs) through our AVM Program. […] Nirav J. Patel, MD, Neurosurgeon at Brigham and Womens Hospital, discusses the treatment and approach to care for an arteriovenous malformation (AVM) diagnosis. […] A team of specialists at Brigham and Womens Hospital Center for Cerebrovascular Diseases (including neurosurgeons, endovascular surgeons, neurologists and radiation oncologists) collaborate to determine the best treatment for each AVM. The best treatment depends on the AVMs location and anatomy and the decision is centered around the patient, to achieve a cure with the least risk. […] Our experienced neurosurgeons, vascular neurologists, and radiologists collaborate closely to determine the best course of treatmentincluding minimally invasive surgeryfor each AVM patient. By applying advanced techniques and delivering comprehensive care, we can bring life-changing results to our patients.

• #14

  https://link.springer.com/article/10.1007/s12028-019-00674-y

  We reviewed retrospectively the perioperative treatment of microsurgically resected brain arteriovenous malformations (bAVMs) at the neurosurgical department of Helsinki University Hospital between the years 2006 and 2014. […] The Helsinki protocol for postoperative treatment of bAVMs was used for the whole patient cohort of 121. […] The Helsinki protocol for postoperative treatment of bAVMs was found to produce comparable results to a more complex treatment algorithm. […] Tight postoperative blood pressure control and a restrictive intravenous fluid management regime are used to decrease the risk of DPH. […] Successful surgical treatment of bAVMs requires good microsurgical skills and anesthesiologic expertise. […] For postoperative treatment, patients are divided to three groups, based on the AVM characteristics and surgical complications (SMG and whether or not the AVM had ruptured preoperatively).

• #15

  https://link.springer.com/article/10.1007/s12028-019-00674-y

  According to the Helsinki protocol, good collaboration between neuroradiologist, neurosurgeon and neuroanesthesiologist is essential when deciding the postoperative treatment. […] The average daily intravenous fluid intake during NICU was 43% higher with patients who had DPH with p=0.052, which borders on statistical significance. […] The five patients who developed DPH show that however hard we try to control the risk factors for DPH, we are unable to completely prevent them from happening. […] The Helsinki protocol used for all the patients in this study focuses on patients blood pressure and intravenous fluid regimen. […] DPH was associated with high SMG, which supports its use in deciding postoperative treatment, complex venous drainage pattern, male gender and high intravenous fluid intake. […] The benefits of simpler protocols are multifarious such as making the implementation of the protocol easier, decreasing the chance for treatment personnel error and reducing the risk for treatment related adverse event.

• #16 Get Arteriovenous Malformation Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/arteriovenous-malformation-treatment

  If you have an AVM, its very important to get treated right away because if the AVM ruptures (bursts), it can cause a brain bleed (hemorrhage). […] Our experts use different therapies to treat arteriovenous malformation. Brain surgery (craniotomy) and gamma knife radiosurgery can cure AVM, but some complex arteriovenous malformations must be shrunk prior to surgery. […] Our neurosurgeons use a sophisticated radiation treatment called Gamma Knife surgery to help stop blood flow to the AVM. […] Sometimes surgery is whats needed to get rid of the AVM. If so, Cleveland Clinic neurosurgeons will do a craniotomy. […] We use a minimally invasive endovascular technique known as embolization to help treat some arteriovenous malformations. […] The cerebrovascular experts at Cleveland Clinic treat ruptured and bleeding arteriovenous malformations precisely and quickly to give you the best chance of recovery. […] If you find out you have one, its important to get treated as soon as possible to avoid a more serious condition. Cleveland Clinic neurologists and neurosurgeons are highly skilled in diagnosing and treating AVMs.

• #17 Arteriovenous Malformations AVMs

  https://www.mhs.net/services/neuroscience/conditions-treatments-services/avms

  When you first step foot in one of our facilities, we evaluate you to determine a baseline for your AVM treatment plan. Our goal is to shrink the malformation enough that it can be treated with radiation or removed through surgery. […] Your AVM treatment may involve a minimally invasive procedure making a few small incisions and inserting a catheter (a small tube) into the blood vessels. This catheter is used to plug up the vessels that are supplying the AVM, which significantly lowers the risk of a stroke. […] Patients who have an AVM diagnosis can visit our neurointerventional radiology team for treatment before a stroke or bleeding occurs.

• #18

  https://www.aurorahealthcare.org/services/neuroscience/brain-skull-base-care/cerebrovascular-malformations/arteriovenous-malformation

  An AVM can be treated in several ways. If the AVM has not ruptured, your doctor will help you weigh the risks of possible hemorrhage against the risks of treatment. […] Your doctor may prescribe medications to help reduce symptoms, such as seizures and headaches. […] In some cases, surgery is needed to repair an AVM. Surgical options include: […] Following treatment, particularly in cases of a ruptured AVM, rehabilitation may be essential to help patients regain lost function and recover from any neurological deficits resulting from the AVM or its treatment. This could include physical therapy, occupational therapy or speech therapy.

• #19 Arteriovenous Malformations (AVMs) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/arteriovenous-malformations

  The choice of treatment for brain arteriovenous malformations (AVMs) is very individual and depends on the AVMs complexity, how easy it is to reach surgically, and whether removing it would risk interfering with vital brain functions. […] In most cases, AVMs are removed by surgery if this option is safe and possible. […] Endovascular embolization is a minimally invasive technique that closes off as much blood flow as possible to the AVM. It can make surgery easier and safer. Embolization is performed under general anesthesia by a neurointerventionalist with the help of specialized anesthesiologists, nurses, and technologists, using X-ray guidance. […] In addition to surgery, some children may also need treatment for any neurological symptoms the AVM may have caused. Treatments can include physical therapy or occupational therapy, or speech and language therapy.

• #20

  https://www.eehealth.org/services/neuro/services-and-specialties/avms/

  Following treatment for an AVM, physical therapy, occupational therapy, speech therapy and swallowing therapy begin in the hospital. The goal of treatment is to help you recover as much function as possible. Recovery time is different for each person. Problems moving, thinking and talking often improve in the weeks to months after treatment.

• #21 Cerebral Arteriovenous Malformation AVM

  https://www.rch.org.au/kidsinfo/fact_sheets/Cerebral_Arteriovenous_Malformation_AVM/

  Prior to going home, frequent family meetings may be held and a potential discharge date will be set. The health care team will discuss ongoing medical management and future goals for your child. If ongoing rehabilitation is required, your child will return to the hospital for outpatient therapy or may be connected with community services for ongoing support. […] Your child will have regular surveillance imaging and follow-up appointments with their treating team. […] A bleeding AVM is a medical emergency and requires immediate attention.

• #22

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc2754

  Your doctor may recommend that you work with a speech therapist or occupational therapist if the surgery affected your speech or your ability to do your daily activities. […] Follow-up care is a key part of your treatment and safety. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if you have any problems.

• #22

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc2754

  A brain arteriovenous malformation repair is surgery to remove a tangled bunch of blood vessels, called an arteriovenous malformation (AVM). […] The incision in your scalp may be sore for about a week after surgery. […] You may feel more tired than usual for several weeks. […] Follow the steps below to feel better as quickly as possible. […] Rest when you feel tired. You may feel sleepy more often than you did before the surgery. […] Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for 2 to 4 weeks or until your doctor says it is okay. […] For 3 weeks, avoid lifting anything that would make you strain. […] You can wash your hair 2 to 3 days after your surgery. […] You will probably need to take at least 6 weeks off from work.

• #23 Living With Arteriovenous Malformation | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-malformation/survival/living-with-arteriovenous-malformation

  As an AVM survivor, you can adopt self-care strategies at home to complement treatments prescribed by your surgeon. Here are some ways to care for yourself at home while living with an AVM: Familiarize Yourself with your AVM Symptoms: Identify your specific AVM symptoms, such as headaches, seizures, or balance issues. This will help you get medical help earlier and prevent your symptoms from worsening. Avoid Triggering Factors: It is essential to be aware of your triggers and take necessary precautions to prevent complications. An AVM survivor should avoid high-impact sports and activities that may increase the risk of head injury. Monitor Your Blood Pressure: Maintaining healthy blood pressure is crucial for an AVM survivor. Regularly monitoring your blood pressure at home, following recommendations from your healthcare provider, and adjusting your lifestyle are essential to maintaining your health. Create a Safe Home Environment: It is crucial to take measures to prevent falls and injuries. This includes removing hazards such as clutter and loose carpets and installing handrails in areas such as the bathroom and stairs. Ensure Emotional and Mental Well-being: Living with an AVM is a challenging experience, both physically and emotionally. It can cause significant stress and anxiety. Therefore, you must seek support from your loved ones, medical professionals, and other social support groups to help you cope with the difficult times.

• #24 Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery: a prospective single-center study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8088033/

  Therefore, a more integrative training and perioperative care could enhance the whole recovery of patients, properly deal with multidisciplinary postoperative problems, and thereby reduce the postoperative complication rate, especially the pulmonary infection and DVT. […] Integrative nursing measures and care would be helpful to enhance these patients recovery.

• #25 Arteriovenous Malformations (AVMs) Diagnosis & Treatment Options

  https://www.dukehealth.org/treatments/brain-arterial-diseases/arteriovenous-malformations-avm

  We are experts in minimally invasive techniques that repair veins and arteries, reduce brain bleeding, and restore healthy blood flow. These options have less risk than traditional open surgery and are much better tolerated. […] Our medical team includes specially trained radiologists who capture and interpret images of blood vessels in your brain, neurosurgeons who regularly perform procedures to reduce or eliminate cerebrovascular disturbances, and other highly trained specialists. We work together to create the treatment plan that’s best for you.

• #26 Arteriovenous Malformation | AdventHealth Neuroscience Institute

  https://www.adventhealthneuroinstitute.com/arteriovenous-malformation

  Some people who have an arteriovenous malformation (AVM) know about their condition early on. […] At the AdventHealth Neuroscience Institute, we specialize in helping people with brain AVMs at all ages and stages, and we know how different the condition can be for every person. […] Your personal Care Coordinator can guide you through every step, from your first AVM screening to your plan for treatment. […] Whether your AVM just needs ongoing monitoring or you’re a candidate for our advanced minimally invasive procedures for AVMs, you’ll find every option you need from the expert neurovascular team at our state-of-the-art facility. […] The biggest concern for people with brain AVMs is uncontrolled bleeding, or a hemorrhage. […] Left untreated, AVMs displaying these symptoms can enlarge and rupture, causing intracerebral hemorrhage or subarachnoid hemorrhage, which can lead to permanent brain damage.

• #27 Arteriovenous Malformations AVMs

  https://www.mhs.net/services/neuroscience/conditions-treatments-services/avms

  Arteriovenous malformations (AVMs) are clusters of abnormal blood vessels. When an AVM forms in the brain, it can interfere with the vital process where the veins and arteries carry blood to the lungs and heart. […] Our aim is to treat AVMs before these blood vessels rupture. If a rupture does occur, it causes a stroke. Memorial Healthcare System offers comprehensive stroke care and the most innovative AVM treatment options. […] Our team of neurosurgeons, neurointerventional surgeons, neuroradiologists, and radiation oncologists meet monthly to develop treatment plans and discuss care for our patients with AVM. […] Research has shown that patients who receive care from physicians of multiple specialties are more likely to have improved outcomes. […] We offer same-day appointments for new AVM diagnoses. Learning that you have an AVM can be frightening. Were here to help put your mind at ease. Together, well develop a treatment plan right away.

• #28 CE Activity | Arteriovenous Malformation of the Brain | Nurses

  https://www.statpearls.com/nurse/ce/activity/38804

  Describe the treatment and management options available for brain AVMs […] Discuss interprofessional team strategies for improving care and outcomes in patients with brain AVMs. […] StatPearls designates this activity for 1.50 ANCC contact hour(s). Nurses should only claim credit commensurate with the extent of their participation in the activity.

• #29 Arteriovenous Malformation Care | Norton Healthcare

  https://nortonhealthcare.com/services-and-conditions/neurosciences/services/arteriovenous-malformation/

  The endovascular neurosurgeons at Norton Neuroscience Institute provide comprehensive arteriovenous malformation (AVM) treatment to patients from Louisville and Southern Indiana. […] AVM treatment options are tailored to individual patients. Patient preference and age, as well as AVM size and location, are important considerations. […] A bleeding AVM is a medical emergency. The goal of treatment is to prevent further complications by controlling bleeding and seizures and, if possible, removing the AVM. […] It’s part of Norton Neuroscience Institute’s goal to care for the whole person, not just the condition. […] Dedicated patient navigators can help schedule follow-up appointments, coordinate prescription assistance, create customized diet plans and provide guidance on disability benefits, housing, financial and employment concerns, and more. […] Norton Neuroscience Institute Resource Center navigators help educate patients and their families about new diagnoses, available treatments and ways to manage their disease.

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