In a remarkable medical achievement, doctors at Rela Hospital have successfully treated a rare brain vascular disorder in a 16-year-old girl without opening her skull. Instead, the complex procedure was performed through a tiny puncture in her thigh, allowing surgeons to access and treat the abnormal blood vessels deep inside her brain.

The teenager from Tiruvallur district was diagnosed with a rare cerebral micro-Arteriovenous Malformation (micro-AVM), a condition in which arteries and veins are abnormally connected without the usual network of capillaries between them. Such malformations can increase the risk of bleeding in the brain and may lead to life-threatening complications.

The girl was diagnosed after undergoing cerebral Digital Subtraction Angiography (DSA), which revealed a micro-AVM located in the posterior frontal subcortical region of the brain. The abnormal vessel network was being supplied by the anterior choroidal artery and draining into the inferior sagittal sinus.

A multidisciplinary team at Rela Hospital opted for a minimally invasive endovascular procedure instead of conventional open-brain surgery. Through a small puncture in the patient's thigh, doctors navigated ultra-thin tubes measuring just 0.007 inches through the blood vessels to reach the abnormal connection deep within the brain.

Once the target area was reached, the team used a specialized liquid embolic agent called Onyx, a medical-grade glue, to seal the malformed blood vessels responsible for the bleeding while preserving the brain's normal blood circulation.

Brain AVMs are extremely rare, with only 0.9 to 1.4 cases diagnosed per 100,000 people globally each year. Pediatric AVMs account for just 12 to 18 percent of these cases. Micro-AVMs are even rarer, as they typically measure less than one centimeter in size, making diagnosis and treatment particularly challenging.

The procedure was led by Dr. Muralidharan Vetrivel, Consultant Neurosurgeon, Cerebrovascular and Neuro-Oncology, along with a team comprising Dr. Natesan Damodaran, Senior Consultant Neurosurgeon; Dr. Anbuselvam, Senior Consultant Neurosurgeon; Dr. Ramanan Rajagopal, Senior Consultant Neuroanesthesia; and Dr. Ravi, Senior Consultant Pediatric Intensivist.

Speaking about the case, Dr. Muralidharan said, “It is rare for a teenager to collapse due to bleeding in the brain secondary to a micro-AVM. Our team successfully treated the condition without the need for open-brain surgery. The procedure lasted only one hour and 45 minutes, and the patient is expected to return to her normal activities after adequate rest and recovery.”

He also urged parents to remain vigilant about persistent headaches in children.

“Parents should seek immediate medical attention if a child experiences headaches that do not settle or begin affecting daily activities and routines,” he said.

The successful treatment highlights how advances in endovascular neurosurgery are helping doctors manage some of the most complex brain conditions through minimally invasive techniques, reducing surgical risks and enabling faster recovery for patients.