AVM Survivors Network

Embolization only a stop gap measure?

Hello - I have been doing extensive research for my AVM condition, what I have learned there are basically 3 treatment options for AVMs:

1. Observation - the doctors watch you for any clinical signs to make sure the condition does not get worse.

2. Surgery - surgical resection via craniotomy.

3. Radiation Treatment - Gamma Knife, Cyber Knife, etc

Missing from the above list is Embolization, which I have read both pros and cons against, and I am interested in community feedback to confirm my understanding.

The gist of it is this - Embolization is used to stop bleeds or hemorrhages, and has been effective for these purposes, however the risk is that by having an Embolization performed there is the possibility that it will put increased pressure on other blood vessels in the brain. These vessels are not used to the new pressure, so Embolization can potentially increase the risk for a bleed or hemorrhage.

Additionally, I have learned that Embolization is only a stop gap measure, and it inevitably still leads down the same road to surgery as the eventual outcome.

I am still learning about AVMs, I know some cannot be treated surgically so the Embolization process is the best option, but it my case I have a small AVM and I am trying to decide whether going through surgery with the associated risks that brings is the best course of treatment for my condition.

If you could have an AVM treated both surgically or via Embolization, which option would you choose?

Thank you.

122014, The jury is still out as to wether or not an embolization will completely eradicate an avm or avf. I had 4 embolizations about 5 years ago, but my initial plan was for surgery after the embos. Following the 1st embo, I presented with acute hydrocephalus and required a VP shunt. It was at that point that the surgery team determined a craniotomy was too risky, so the plan shifted to more embolizations plus 8-10 Cyberknife treatments to follow. After my fourth and final embolization in 3/10, all of the left-side stroke symptoms had improved and after meeting with the radiation oncologist regarding Cyberknife it was determined that that too was dangerous! I decided to stop treatment then, with my avm only 40-45% embolized. I have remained relatively symptom-free for the last 5 years. I do know that my avm is still there, only partially embolized. If given the choice between surgery or embo alone, I think surgery has proven to be the most effective. Please check out my posts regarding embolizations here. Good luck with your research. GK

I had both. I had a major hemorrhage which led to the discovery of my AVM (right frontoparietal).I had the first embo going in the right side of the groin which was successful with 15% closure. The second embo went in on the left but the AVM feeder artery was not reachable so the procedure was aborted and I ended up having complete resection via craniotomy. Under normal circumstances, due to the location of the AVM (nestled between the motor cortex and somatosensory cortex along the central sulcus), I would have just had the embos and *possibly* SRS/GK because the risk of permanent damage as a result of surgery would have been too high. BUT, I had a bleed large enough to permanentally restrict the movement of my entire left side plus I was also pregnant. A bleed that size increases risk of a secondary bleed without any treatment (obviously haha) and once I reached third trimester I was at even higher risk of a second bleed bnecause of BP and all that which all doctors agreed that either I or my baby, possibly both, would not survive. So embo attempts followed by a crani were my only real options. Research is incredibly important. There really aren't many options as the ARUBAresearch shows. In a lot of cases it's best to monitor but no one really knows the long term effects without intervention. Good luck on your research :)

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