Treatment of a 2.5 x3 cm. AVM already treated with embolizations and Gamma Knife

Posted By Debbie on February 02, 1999 at 13:25:53:







History: When I was 9 yrs. old I suffered a fractured skull (plate on left side of head) when I was hit by a truck.  I then began experiencing seizures, mostly petit mal in nature, on my left side.  When I was 21 yrs old, tests finally revealed a right posterior frontal, anterior parietal AVM measuring 5-6 cm. My case was then reviewed by a panel of both Neurologist and Neurosurgeons.  At that time, my options were to leave it alone or to have surgery.  The panel could not come to a consensus on a course of treatment, I chose to leave it.  Seizures and constant headaches, along with migraines continued, treated with Dilantin and Phenobarbitol and various types of pain meds for migraines.  9/93 Started to experience a constant high frequency noise in left ear and began looking into treatment of AVM, please note, I have been seen by a Neurologist since 63 and have been evaluated for many different types of treatment.  After evaluation by a NeuroRadiologist, A Gamma Knife Surgeon and a Neurosurgeon, the consensus was to leave it alone.  8/94 my AVM hemorrhaged, I then had three embolizations, two without incident. The day following the second hemorrage, I experienced a slight stroke resulting in some weakness in my left arm and the left side of my face.  Surgery was to be performed following the embolizations however, my Neurosurgeon left the country and my window opened by the embolizations, was now closed.  New Surgeon...9/95 Gamma Knife Surgery performed. Seizures increased initially, but are now minimal.  Experienced swelling around the radiated area, resulting in weakness and loss of sensation on my left side (I need to wear a brace on my leg to prevent my knee from giving out).  The AVM has been reduced to 2.5 x 3 cm.  At this point, my Gamma Surgeon wants to perform Gamma again, my Neurosurgeon wants to perform Surgery and while my Neurologist is concerned with open surgery, he is also worried about further radiation therefore, he is on the fence at this point.  Help...I am married with a family and I am having a difficult time with this decision. I would like to somehow balance the positives and negatives of both procedures.  I'm so sorry about the length of this message, but I thought you might like to know my history before voicing any opinion.   Thank you
DebbieB.