A patient, aged 30 and residing in Pune, with a rare and challenging blood vessel disorder in the right ear has undergone a groundbreaking treatment at Sahyadri Hospitals, Hadapsar. The complex case involved multiple interventions over the course of more than a year, culminating in an advanced treatment strategy led by Dr. Sanjay MH, lead Radiation Oncologist at Sahyadri Hospitals. The innovative approach effectively combined advanced embolization and cutting-edge stereotactic radiosurgery, tailored to such complex conditions.

In April 2022, the patient came to the hospital with symptoms including swelling, redness, and occasional bleeding from the right ear. The initial medical tests identified an arteriovenous malformation (AVM), a condition where blood vessels are abnormally connected, disrupting normal blood circulation. This can lead to serious complications if left untreated, such as bleeding or heart problems due to the strain of blood pumping through these abnormal connections.

To manage the patient’s AVM, a procedure called embolization was first performed in April 2022. This involves inserting a material through the blood vessels to block the abnormal connections, thus reducing the risk of bleeding and other symptoms. Despite some initial improvement, the AVM persisted, and symptoms reappeared by December 2022. Further imaging showed that the AVM had grown. The medical team decided to perform another embolization followed by a surgical procedure on December 29, 2022, to remove the problematic tissue and reconstruct the affected area. This combination led to an improvement, with a reduction in the AVM by 60-70%.

However, in March 2023, the patient experienced a mild increase in symptoms, and by July, a significant bleeding episode occurred. The patient’s preference to avoid drastic measures like amputation of the ear led Dr. Sanjay to consider an innovative treatment approach: stereotactic radiosurgery. This highly precise radiotherapy technique targets the AVM with focused radiation beams while minimizing exposure to surrounding healthy tissues. For this particular case, the ELEKTA Synergy system was utilized, a device known for its ability to deliver radiation with extreme precision. The treatment involved delivering a total radiation dose of 21 Gy divided into three sessions from This approach helped to preserve the ear’s function and appearance without the need for more invasive surgery.

Dr. Sanjay MH, explains, “Using stereotactic radiosurgery, we were able to effectively treat the remaining abnormal blood vessel connection, known as an arteriovenous malformation (AVM), while also respecting the patient’s wish to avoid extreme measures like ear removal. This treatment targets the AVM directly and uses radiation to destroy the cells lining the abnormal vessels, leading to their breakdown. AVMs often respond slowly to treatments, so we continued to check on the patient’s progress over a long time to be sure the treatment worked as expected. The ELEKTA Synergy system, a specialized device, was critical in focusing the treatment precisely on the AVM and protecting the nearby healthy tissues, helping to maintain the patient’s quality of life.”

Dr. Sanjay added regarding the post-treatment care, “Following the treatment, the patient was closely monitored for any immediate side effects, which were managed with appropriate medications to alleviate symptoms like skin irritation. Regular follow-up appointments have been scheduled to monitor the treatment’s long-term efficacy and to check for potential complications. So far, the patient has shown significant improvement, with reduced symptoms and no major complications.”

This pioneering case is significant as it marks one of the first uses of stereotactic radiosurgery for treating an AVM in the external ear, demonstrating Sahyadri Hospital’s innovative approach in medical treatments. The successful management of this case could open new pathways for treating similar vascular abnormalities in less accessible or more sensitive areas of the body.