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So an AVM is an abnormal tangle vessels 脑动静脉畸形（AVM）是一种纠结成团的血管畸形，
where arteries connect through a tangle 动脉通过缠结在一起的
of weakened vessels to a vein.Normally, 脆弱血管与静脉连通。通常，
arteries divide into ever smaller 动脉会逐渐分支为越来越小的血管，
vessels until you get to the capillary 直至其达到非常纤细的
level where the vessels are very tiny 毛细血管水平为止，
and at that level capillaries can unload 在此水平毛细血管可以释放
oxygen and nutrients and pick up co2 and 氧气和营养物质并回收二氧化碳，
then from there the blood is collected 然后从那里通过小静脉
by small veins that go into ever larger 收集血液，逐步至越来越大的静脉，
veins but then go back to the heart. 最终回流至心脏。
With an AVM however the arteries connect to a 然而在AVM中，动脉与缠结的
tangle of weakened arteries and that 薄弱动脉连接在一起，
flow goes right into a vein so as a 血流直接进入静脉，因此
result the veins see arterial pressure 静脉直接遭受动脉压的冲击，
normally venous pressure is much lower 通常情况下静脉压比动脉压
than arterial pressure.When an AVM the 低得多。在AVM中，
veins are at under high pressure and 静脉处于高压状态，
veins don't like high pressure so that 而静脉不能耐受高压，
tends to lead to inflammation and 从而易于导致炎症，
sometimes aneurysms can form and those 甚至有时会形成动脉瘤，而
aneurysms can lead to rupture, and when 动脉瘤可能导致血管破裂，而当
an AVM bleeds that can be occasionally AVM出血时，后果有时可能是
catastrophic or lead to neurological injury. 灾难性的或导致神经损伤。
It would be the equivalent of a 这就相当于一根立柱
column that's designed to hold up a 本来被设计用以支撑一个
cardboard roof putting a cement roof on 纸板屋顶，而此时在立柱上面放
that on that column will result in the 一个水泥屋顶就会导致
column collapsing. 立柱崩塌。
So one of the challenges with 因此，了解AVM及其
understanding AVM's and their treatment 治疗选择所面临的
options is the fact that they are very 挑战之一是AVM具有
complicated three-dimensional structures. 非常复杂的三维结构。
That we often see 2d images and we try 如果我们经常看到的是2D图像，那么我们
to you look at 2d images to understand a 就会尝试观看2D图像以了解
three-dimensional problem.So we've been 三维问题。所以我们
using 3D printing and holography to try 一直在使用3D打印和全息技术
to get a better understanding of them. 来更好地了解它们。
One for the benefit of the treating team so 一则是为了治疗团队的获益，
that we can better think through what we 这样我们就能更好地思考我们
may or may not be able to do for the patient. 能为患者做什么或不能做什么。
But the second is to also 二则也是为了教育患者，
educate the patient regarding their problem. 让他们了解自己的病情。
So this is a 3d print of an AVM. 这是AVM的3D打印。
Here you can see some normal vessels and 这里你可以看到一些正常的血管
we can see here is what I would call the 另外这里我们看到的就是我所称谓的
bowl of spaghetti.These are fragile 一碗意大利面。它们是脆弱的
vessels that can pop easily.They're not 血管，极易破裂。它们不习惯
used to or they're not designed to carry 或其结构设计并不适合承受
high pressure so they can break and 高压，所以它们会破裂或
rupture and that can cause brain bleeding. 迸裂进而导致脑出血。
So as we look at this model we 因此，当我们看到这个模型时，我们
can start to rotate it and think about 可以开始旋转它，并考虑
what vessels are coming into it. 有哪些血管进入血管团。
That'swhat we call feeding arteries abnormal 这就是我们所说的供血动脉，
vessels that come into this tangle the 作为异常血管进入缠绕成团
spaghetti bowl so to speak.And what you 我们所说的意大利面碗里。你们在
don't see on this model clearly is that 这个模型上看不清楚的是
there's usually a vein coming out. 这里通常有一根静脉引出。
And when we go in with surgery we usually 当我们进行手术时，通常我们的
our goal is to separate this mass from 目标是将这些团块与
the surrounding brain tissue safely 周围的脑组织安全分离
while preserving the normal arteries and 保留正常动脉的同时并将
removing it from the patient.That may or 血管团从患者身上移除。这种术式
may not be safe depending on the 是否安全取决于
specific anatomy of that patient. 患者的个体解剖差异。
Additionally an AVM of this size for 另外，例如这种大小的AVM
example it may be very beneficial to 在术前将一些液体栓塞胶
inject some glue into the AVM before 注入AVM可能是非常有益的，
surgery to make the surgery safer. 这样可以使手术更为安全。
So what we would do is under fluoroscopy we 所以我们要做的是在X线透视下，
would navigate a very tiny catheter and 我们将操纵一根非常小的导管，
let's say this artery and get into an 假设是这个动脉，使微导管进入该
artery where it would be safe to inject 动脉，通过该动脉可以安全地将
glue into the AVM.We would watch glue 栓塞胶注入AVM。我们将看到
percolate into the AVM plugging up these 栓塞胶渗入AVM，堵塞了这些
no abnormal small arteries and that may 没有异常的小动脉，这可能
make the surgical plan and execute the 使手术计划和执行
surgical option much much easier to implement. 手术方案更加容易实现。
Just like snowflakes are no 就像雪花一样，没有
two AVM that are the same.Every AVM is 任何两个AVM是相同的。每一个AVM
different because it how close you look 都是不同的，无论在你看来有多相像，
and our treatment plans also have to be 我们的治疗计划也必须
unique and uniquely designed to match 独特且设计独有，才能
the needs of the patient.So the 满足患者的需求。因此，
treatment options for AVM include microsurgery AVM的治疗选择包括显微外科手术，
that's where we threw at crania 在该手术中，我们打开
a cranial opening in using the operating microscope. 颅骨后，在手术显微镜下进行操作。
We can look at the anatomy of 我们可以观察AVM的
the AVM and disconnect the abnormal 解剖结构，将异常的动脉从
arteries from the surrounding 周围循环中
circulation 断开，
remove the AVM.The second treatment 移除AVM。第二种治疗
option is embolization where a catheter 方案是介入栓塞，将一根
the size of an angel hair pasta can be 意大利通心粉大小的动脉导管置入
placed into the AVM and glue can be AVM中，并可以注入栓塞胶
injected to occlude those abnormal 封堵那些异常的
vessels to make them put to plug them up 血管，使之栓塞
that can be done.In some cases to 从而闭塞。一些可以
completely cure an AVM typically for 完全治愈的AVM病例，通常
smaller AVM that have one or two feeders. 是针对具有一个或两个供血动脉的较小AVM。
The other treatment option for a TMS is AVM的另一种治疗选择是
radiosurgery.Or we use radiation to 放射外科。亦即我们使用放射线
shrink an AVM that treatment has the 来缩小AVM，这种治疗
advantage of being minimally invasive 本质上具有微创的
essentially and it's an outpatient procedure. 优势，而且是门诊手术。
But it does take several years 但这需要几年的时间才能
to work.So patients can continue to have 奏效。因此，患者在此期间
risk of bleeding during that period. 可能仍有出血的风险。
But for AVMs that cannot be removed 但是对于无法通过手术切除
surgically for AVMs that are in 的AVM，涉及AVM
locations that are undesirable from a 对手术而言处于不理想的
surgical standpoint or in patients who 位置，或由于
cannot tolerate surgery either due to 年龄或其他合并症而无法
age or other comorbidities. 耐受手术的患者。
Radiosurgery may be a good option. 放射治疗可能是一个不错的选择。
Another option for larger AVM is to do 对于较大的AVM，另一种
is to use staged radiosurgery.Where we 选择是采用分阶段放射治疗。我们
treat the AVM in different pieces.So if 将AVM分为不同的部分。如果
an AVM is too big for a single shot of AVM太大，无法一次进行
radiation we can potentially break it up 放射治疗，我们可以将它
into two or three pieces and do it over 分解成两到三部分，
the course of three to six months. 在三到六个月的时间内完成。
Andfinally of course though there is an 最后，对于一些特定的AVM
innovative option for some AVMs and 有一个创新选择，
that's proton beam therapy and proton 那就是质子束疗法，
beam therapy has been used successfully 质子束疗法已经成功地用于
treat certain AVMs. 治疗某些AVM。
But again the treatment does take time 但是同样，这种治疗的确需要时间，
and not all AVMs can be occluded with 而且并不是所有的AVM都能被这种
this technique.So each of these 技术所堵塞。因此，每种
techniques has pros and cons. 技术各有利弊。
It'simportant for every patient who would 对于每一个想要治疗
like to treat their AVM to really 其AVM的患者来说，真正
carefully get educated about all those 认真地了解所有这些
treatment options and how they can 治疗方案以及它们是如何协同工作的
potentially work together.Patients with 至关重要。AVM患者
AVM should have hope and AVMs can be 应该抱有希望，AVM可能
scary but with modern treatments there 令人恐惧，但有了现代治疗方法，
has never been a better time in the 此时也许是历史上从未有过的更好时光，
history maybe I'm treatment for patients 对于我们正在治疗的
with AVM`s. AVM患者而言。