My husband has a 2cm AVM that was embolized last year.

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My husband has a 2cm AVM that was embolized last year.

Question from Kim: 

My husband has a 2cm AVM that was embolized last year. He was supposed to undergo a resecection but was cancelled and he was released from the hospital because of the apparent embolization success. At his year follow up they see a difference in the angio suggesting that a tiny piece has "come back". There doesn't appear to be any vein filling yet. They suggest Gamma Knife to treat the AVM to get the remaining area. My sister in law's father had the Gamma Knife surgery years ago and experienced severe swelling that have damaged his motor skills. His AVM was deep set and larger. My husband is just next to the vision area. She warned me that my husband could also have swelling that might cause permanent motor skill damage even though his AVM is not in that area. Is that true? We have an appointment to meet with the neurosurgeon on the surgical team at UT Southwestern but that is not for several weeks and we are curious. Thanks so much! 

Dear Kim,
 
At present, embolization is typically utilized as an adjuvant treatment for AVM's in conjunction with surgical resection or stereotactic radiosurgery.  In rare instances, very small AVM's can be permanently obliterated via an embolization.  Unfortunately, as sounds like the case for your husband, AVM's can recanalize following embolization.  A patent AVM carries an annual risk of hemorrhage that is estimated to be about 3%.
 
Gamma Knife surgery is the gold standard for radiosurgical treatment of intracranial AVM's.  The rate of successful obliteration at my center for optimally treated AVM's is approximately 80%-85%.  In hundreds of AVM patients treated at the University of Virginia, long-term follow-up reveals an approximately 1.5% risk of Gamma Knife induced injury.
Thus, the benefit to risk profile for Gamma Knife surgery of AVM patients is very favorable--even for some very difficult to treat (e.g. deep seated or eloquently located) AVM's.
 
Our center's updated results will be published in the Journal of Neurosurgery early in 2007.
 
Let me know if I can be of further assistance.
 
Best wishes,
Jason Sheehan