my brother has an AVM located in a peduncle in the left cerebellum
Question from David:
Dear Dr. Sheehan, my brother has an AVM located in a peduncle in the left cerebellum. The AVM is approximately 1cm in diameter. Partial embolization of the AVM reulted in a severe right side stroke, from which he is recovering well. Gamma Knife treatment has been recommended to completely obliterate the AVM. The risk of permanent neurological deficit as a result of G-K treatment has been quoted as 4-6% since the AVM is in an eloquent area of the brain. Do you and your colleagues have data from clinical experience at your institution that would indicate a lower risk of permanent deficit can be achieved for small AVMs in similar locations. My brother lives in England but we would consider having him treated in Virginia if there was a significantly reduced chance of severe deficit, as a result of your experience and expertise with the G-K. My apologies for the very focussed nature of this question, but my brother has been through a lot and we want to minimize the chance of any further undesirable side-effects. Many thanks, Sincerely, David
Your question is very detailed and speaks to the difficulty of treating intracranial AVM's. I certainly appreciate your desire for the very best outcome for your brother particularly given all that he has been through in the past.
Small to moderately sized AVM's can be obliterated 80-85% of the time with a single Gamma Knife surgery. Those that have had prior embolization can present a challenge at times if the nidus (i.e. the core) of the AVM has been broken into discrete, non-contiguous parts. My partner, Dr. Steiner, was the first to treat an AVM with the Gamma Knife. In the more than 2000 AVM's treated at UVa, we have observed long-term complications in about 2-3% of patients who have AVM's optimal for treatment with the Gamma Knife. Such patients include those with compact small volumed AVM's even if they are in eloquent areas.
I cannot tell you the specific risk to benefit profile for your brother until I have seen his recent MRI/A or cerebral angiogram. I would be happy to review these neuro-imaging studies and relevant clinical history. Please send the information to my attention at the following address:
Lars Leksell Center for Gamma Surgery
University of Virginia
Primary Care Center
1215 Lee Street
P.O. Box 800742
Charlottesville, VA 22908-0742 USA
Toll Free Number 1-866-244-4040