Decoding AVM, Brain Aneurysm and Trigeminal Neuralgia – A Neurosurgeon’s Lifesaving Guide

Verified By Dr. Varun Bhargava | 24-Jun-2025

Dr. Varun Bhargava, Sr. Consultant Neurosurgeon at Kailash Hospital, leans forward intently: "Imagine living with a ticking time bomb in your brain – that’s the reality for patients with undiagnosed AVMs or aneurysms. When Bollywood icon Salman Khan revealed his battle with this neurological triad, he spotlighted conditions affecting millions who remain unaware until catastrophe strikes." Today, over 3.4 million Indians unknowingly harbor brain vascular abnormalities, while trigeminal neuralgia torments 1 in 25,000 with "suicide disease"-level pain. This guide demystifies these silent threats – their dangers, symptoms, and revolutionary treatments saving lives today.

1. Arteriovenous Malformation (AVM)

An arteriovenous malformation (AVM) occurs when arteries and veins connect directly without capillaries, forming a tangled nidus that can rupture or compress nearby structures. "Think of it as faulty plumbing," explains Dr. Bhargava. "Blood rushes through at bullet-speed, thinning vessel walls until they rupture".

Stealth Symptoms You Must Not Ignore

• Seizures: Sudden electrical storms from oxygen-starved brain tissue
• "Thunderclap" headaches: Explosive pain signaling micro-bleeds
• Cognitive fog: Memory loss from frontal lobe "blood theft"
• Pulsatile tinnitus: Whooshing sounds audible only to the patient

"60% of AVMs announce themselves through hemorrhagic strokes in people under 40," warns Dr. Bhargava.

Cutting-Edge Treatments at Kailash Hospital

• Embolization: Injecting glue-like Onyx-18 into vessels via catheter (80% success in reducing rupture risk)
• Gamma Knife Radiosurgery: Focused radiation shrinks AVMs over 2-3 years (90% obliteration for <3cm lesions)
• Hybrid Surgery: Combining embolization and microsurgical resection for complex cases

2. Brain Aneurysm

Aneurysms form when blood pressure weakens arterial walls, creating blister-like pouches. Rupture causes hemorrhagic strokes with 40% mortality.

Table: Aneurysm Risk Factors

The "Silent Phase" Deceptions

Unruptured aneurysms often show no symptoms, but subtle red flags include:

• Partial ptosis: Drooping eyelid from oculomotor nerve pressure
• Diplopia: Double vision during lateral gaze
• Periorbital pain: Dull ache behind the eyes

"Salman Khan’s revelation is crucial – he functions normally despite his aneurysm because early detection enables monitoring," notes Dr. Bhargava.

Emergency Protocols for Rupture

When aneurysms burst:

1. Golden Hour Intervention: Coiling within 60 minutes improves survival by 70%
2. Neuro-ICU Management: Controlling intracranial pressure with hypertonic saline
3. Vasospasm Prevention: Nimodipine infusions to prevent secondary strokes

Also read: Stroke and its main warning signs: Things to know

3. Trigeminal Neuralgia

Trigeminal neuralgia (TN) causes shock-like attacks of pain along the trigeminal nerve (face), sharply disrupting daily life. It often results from vascular compression, including rare AVM involvement.

Shock Triggers Beyond Cold Air

• Chewing: Jaw movement displaces vessels, increasing nerve compression
• Shaving: Tactile hyperesthesia in V2/V3 distributions
• Toothbrushing: Allodynia converting light touch to agony

"I’ve seen patients starve themselves to avoid triggering pain," shares Dr. Bhargava.

AVM-Induced Neuralgia: A Deadly Duo

When AVMs cause trigeminal neuralgia:

• Dilated "red veins" pulsate against the trigeminal root entry zone
• Feeder artery aneurysms increase compression risks
• Treatment complexity rises – embolizing vessels may worsen nerve irritation

4. When the Triad Collides: Salman Khan’s Revelation

Khan’s disclosure highlights critical challenges:

• Action Star Peril: Stunt work elevates systolic BP >180 mmHg, increasing aneurysm rupture risk
• Medication Dilemmas: Carbamazepine (neuralgia drug) interacts with anesthesia during emergencies
• Cumulative Damage: Multiple conditions accelerate brain aging through micro-injuries

"His ability to work is exceptional – most patients with this triad require activity modification," states Dr. Bhargava.

5. Diagnostic Revolution: Seeing the Unseeable

Beyond Basic MRI

• 4D Angiography: Real-time blood flow mapping showing "steal" patterns in AVMs
• Diffusion Tensor Imaging: Visualizing nerve deformation from vascular compression
• Thermocoagulation Mapping: Identifying hyperactive trigeminal nerve branches

"We now detect millimeter-scale aneurysms with AI-enhanced imaging – impossible five years ago," notes Dr. Bhargava.

Also read: Understanding Left Side Stroke Symptoms: Early Signs and Recovery Insights

6. Treatment Breakthroughs at Kailash Hospital

AVM-Specific Advances

• Pressure-Directed Embolization: Smart catheters measuring intravascular pressure during glue injection
• Hybrid OR Suites: Combining surgery and angiography for real-time monitoring

Aneurysm Innovations

• Intrasaccular Flow Diverters: Woven mesh tubes promoting clotting without coils
• Bioabsorbable Stents: Dissolving scaffolds regenerating healthy vessels

Trigeminal Neuralgia Solutions

• Gamma Knife Esprit: Sub-millimeter radiation targeting nerves (80% pain relief)
• Endoscopic MVD: Minimally invasive decompression via 1cm incision

7. Prevention Framework: Dr. Bhargava’s 5-Point Shield

1. Genetic Screening: For first-degree relatives of AVM/aneurysm patients
2. BP Management: Nighttime monitoring (most ruptures occur 4-6 AM)
3. Trigger Avoidance: Skipping Valsalva maneuvers (heavy lifting, forceful coughing)
4. Dietary Protection: Berries (anthocyanins strengthen vessel walls) and omega-3s
5. Annual Neuro-Check: Including quantitative pupillometry for asymmetry

"Prevention isn’t passive – it’s actively optimizing brain health daily," emphasizes Dr. Bhargava.

Conclusion: Silent Cerebral Conditions—Handle with Care

While brain AVMs, aneurysms, and trigeminal neuralgia often go unnoticed, each carries serious risks. Awareness, professional screening, and prompt intervention can safeguard lives and quality of life. At Kailash Hospital, Noida, Dr. Varun Bhargava and his team are at the forefront of diagnosing and treating these silent but powerful neurological challenges with precision, expertise, and compassion.