Cellular Biology of Brain Blood Vessel Abnormalities

A/Prof Marcus Stoodley, Prince of Wales Hospital

Professor Marcus Stoodley, a neurosurgeon in the Department of Neurosurgery at the Prince of Wales Hospital and the University of New South Wales, has received grants for three years from the Brain Foundation for his research work on congenital lesions of the brain that cause stroke or seizures in younger people.

These lesions, known as arteriovenous malformations (AVMs), occur in approximately 1.8 –2% per 100,000 of population per year, and the risk of rupture is 2 – 4%. Each rupture has a mortality rate of 10-30%, and a neurological morbidity rate of 40-80%. Most patients are younger than 40 – the resulting mortality and morbidity therefore have a dramatic impact when measured in loss of quality adjusted life-years.

Prevention of haemorrhage can be achieved only by complete obliteration of the malformation. In general, three methods are used –surgical excision is the treatment of choice for most small (less than 3cm) and medium-size (3-6cm) AVMs. Stereotactic radiosurgery is an attractive alternative to surgery, however it can only be used on lesions of less than 3cm in size. Even then, the obliteration rate is only 70-80% and the success of the surgery is dose-dependent. Higher radiation doses have higher cure rates, but the risk of neurological deficits from necrosis of surrounding brain limits the radiation dose.  The third general treatment is blockage of the of the blood vessels with special glue injected through a catheter inserted in the groin and passed up through the aorta into the brain arteries. This technique is rarely curative and is generally used as an adjunct to surgery, radiosurgery, or both.

Large (greater than 6cm) AVMs are difficult to treat by any method. Current management techniques use all of the three methods described above, but the results are not as good as those achieved with smaller lesions.

Dr Stoodley’s research aims to improve radiosurgical treatment so that it is suitable for larger AVMs and also more effective for small AVMs. The Brain Foundation has assisted in this work by providing funding originally for purchase of the microscopy system shown in the photo and complementary systems such as the digital imaging system and fluorescence attachment, and a cell culture incubator.

Professor Stoodley (left) and members of his research team with the microscopy system funded by Brain Foundation grants.