Dr Bhatia provides caring advice and treatment for children and their families in a comfortable and safe environment.

Dr Bhatia has highly specialized expertise in the management of Vein of Galen Malformations (VOGMs), a rare and serious high-flow malformation of the blood vessels deep in the brain that affects newborn babies and infants. VOGMs can cause cardiac failure after birth, enlarged fluid spaces in the brain in infancy, and developmental delay later in childhood. Working in a team with his colleague Dr David Lord, Dr Bhatia can help you to understand the condition and the risks it poses to your baby, to help co-ordinate the care of your baby prior to, during, and after delivery, and to undertake the complex embolization procedures needed to reduce the flow in the malformation.

VOGMs are often diagnosed on third trimester ultrasound but sometimes are missed until after birth. If your third trimester ultrasound has shown that your baby has a VOGM, please arrange a consultation with me at Sydney Aneurysm so we can organize care for your child. Most often we will ask your obstetrician to arrange for a colleague of theirs to deliver your child at Westmead Hospital, after birth we will arrange admission for your baby to the Neonatal Intensive Care Unit at Children’s Hospital Westmead,  we will perform an MRI to map the malformation, and we will then advise you if we think treatment is likely to be helpful (we usually offer treatment in around 3 out of 4 cases). Based on the degree of flow we decide on the timing of the first procedure – but often this is in the first week of life if there is concern for heart failure developing.

We aim to slowly bring down the flow in the VOGM over 3-5 sessions spaced over the first year of your baby’s life. Our aim is to slow down the VOGM to try and give your child the best chance of a good long-term outcome. Whilst we often cure the malformation, this is not our main goal – we aim for a good long-term neurological outcome. Unlike other vascular malformations in the brain, VOGMs are not known to bleed outside the setting of treatment-related complications. We aim to save your baby’s life by preventing heart failure, and then improving their quality of life by trying to prevent developmental delay.

At Children’s Hospital at Westmead, we undertake more VOGM embolizations than any other centre in Australia and are world leaders in the use of lava-like liquids (Onyx, PHIL) to close off the arteries feeding the VOGM. Dr Bhatia has published the most up-to-date publication on outcomes after VOGM embolization and how to avoid complications based on his research into the condition in Toronto – published in the prestigious JAMA Neurology.

Dr Bhatia was trained by world-renowned experts Professor Timo Krings and Professor Vitor Mendes Pereira in the complex techniques required for embolization of brain AVMs. Most INR practitioners in Australia have very limited experience with this procedure because in many cases neurosurgeons have historically preferred open surgery for this condition.

For you and your child, a diagnosis of a brain AVM can be confronting, and the malformations tend to bleed at a rate of 2-3% per year. Whilst that might sound small, over the span of your child’s life this poses a significant risk of bleeding and associated death or disability.

Dr Bhatia can provide you with caring and expert advise on the risks faced by your child from conservative treatment (watch and wait), from minimally-invasive endovascular treatment (through the arteries or veins of the thigh), and from multi-modal treatment (combining embolization procedures that reduce the size of the AVM with surgery or radiosurgery).

When you have a consultation with us at Sydney AVM, we will review your child’s cerebral angiogram if previously performed or arrange for them to have a new one of the highest quality at Children’s Hospital at Westmead – performed by Dr Bhatia. Based on the appearances of the AVM on the angiogram, Dr Bhatia can provide you with detailed advice on the feasibility of endovascular treatment for cure or reducing the size of the AVM, the risks your AVM may present to your child, and the various treatment options available – including the watch and wait approach in some cases where appropriate.

There is increasing evidence that brain AVMs are associated with a localized mutation in a gene called K-RAS in many cases, affecting only that part of the brain. There is increasing interest in a drug called trametinib that blocks the pathway K-RAS is involved in but as yet there have been no proper studies performed – in the next 10 years I expect medications will start to play a larger role in the treatment of brain AVMs.

In some cases (perhaps 5-10% of all cases), brain AVMs are associated with an inherited condition called Hereditary Haemorrhagic Telangiectasia (HHT) that also causes nose bleeds and lung vascular malformations. Dr Bhatia has significant expertise in the management of HHT, and as a fully qualified paediatric interventionist he can also undertake treatment of the lung vascular malformation for your child if appropriate.

In addition, if your child has HHT -  Dr Bhatia can assist you in organizing screening MRI studies of the brain to look for AVMs and specialized echocardiograms looking for lung vascular malformations on a regular basis to help detect these lesions early and prevent strokes and bleeds that can occur when they are not identified.

Vascular malformations commonly present during childhood and can cause pain, swelling, and sometimes disfigurement for you child. I am extensively trained in diagnosing vascular anomalies, interpreting the imaging (ultrasound and MRI), and performing the full range of sclerotherapy and embolization procedures to help shrink down your child’s condition.

I am more focused on improving the quality of life your child experiences than just curing the condition – so you can be assured I will not take unnecessary risks.

Expertise in vascular anomalies allows us at Sydney AVM to ensure that a more widespread condition is not being missed. Some children have more extensive conditions (such as Klippel-Trenaunay Syndrome, Parkes-Weber Syndrome, CLOVES Syndrome, CM-AVM, FAVA) who require specialized multi-disciplinary care – these condition are easily missed by practitioners who focus only on treating the malformation they can see.