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Fall 2016
Champion Charles
Young Patient Survives & Thrives After Arteriovenous Malformation Rupture

Pictured above: In the years following his AVM surgery, Charles has taken the mound at Cooperstown, taken the stage at Merlefest and take up snowboarding
When Margaret and her 10-year-old son, Charles, arrived at the hospital on the morning of August 9, 2013, pediatric neurosurgeon Scott Wait, MD, of Carolina Neurosurgery & Spine Associates was on call.

“I truly feel that it was by the grace of God that Dr. Wait was there,” said Margaret. “From the moment he told us he would take care of things, I felt confident we were in the right hands.”

The intracranial pressure was so high that not all of the necessary diagnostic testing could be immediately performed on Charles. The doctors and staff managed his symptoms until they could get answers. Dr. Wait determined that Charles had an arteriovenous malformation (AVM) that had ruptured.

An AVM is an abnormal connection of blood vessels typically found in the brain or spinal cord. These tangled vessels form a direct connection between the arteries and veins, resulting in venous hypertension. When an AVM ruptures it can cause devastating bleeding and death. The bleeding can result in symptoms such as seizure, headache, paralysis, speech and vision problems. People are typically born with AVMs and it is estimated that less than 1 percent of the population harbor an AVM.

Charles remained in the ICU for three weeks. The increased pressure in his head caused by the AVM had to be managed until he was stable enough for surgery. During that time, Dr. Wait and the team of pediatric and cerebrovascular neurosurgeons at Carolina Neurosurgery & Spine Associates developed the best possible plan of care for Charles.

Dr. Wait performed a craniotomy for the resection of the AVM and removal of the hematoma. Craniotomy is the most common surgical procedure used to remove an AVM. During surgery, an opening is made in the skull and the natural clefts in the brain are accessed for the AVM to be removed in the most minimally invasive way possible. In some cases, embolization, performed by endovascular specialist Joe Bernard, MD, is used to make the surgery easier for the surgeon and safer for the patient. Some patients have AVMs that are more appropriate for stereotactic radiosurgery, which are performed by Carolina Neurosurgery & Spine Associates neurosurgeons.

Immediately after the surgery, while Charles was still under anesthesia, Dr. Bernard performed an angiogram to confirm cure of the AVM. Charles spent the next month in rehabilitation rapidly regaining most of the function that the AVM rupture had taken. Three years later, Charles is enjoying a full and active life.

“I wasn’t sure if my son would live through the day,” said Margaret as she reflected on that August morning. “I never imagined we would be happy, smiling, running around the world again. Now we are, and I’m so very grateful.”
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