Hi guys, it seems after doing some reading on Gamma Knife that quite often the residual is removed via surgery some time later, is this fairly common? Does GK not generally totally obliterate?
One or The downside of any type of radiation to obliterate an AVM is TIME it takes to work.
Often, in a large AVM, such as what my wife had, the initial prognosis was "learn to live with it--it's too large to treat conventionally." But she did have PBR at a low dose.
Ten years later, in a followup with more advanced DRs, they suggested that Proton Beam Radiation (PBR) had reduced it some, and they could do embolizations. After 4 embos, the AVM was small enough, they did microsurgery to remove the remainder.
If radiation gets it small enough to do surgery, I think that's a decent option.
I had my second GK a week ago. What one of the doctors told us is that the GK creates scar tissue that remains there.
My original plan of treatment was 3 rounds of GK followed by a craniotomy. Then, it changed to 2 rounds of GK, w/ no craniotomy. It is now back to 3 rounds of GK, but no craniotomy.
When they were planning planning last week's GK, they decided it would be safer to work on 85% of the remaining area at that time & the last 15% in 6 months, rather than trying to get it all at one time.
Hi Ron, thanks for your reply, I too think it is a decent option, I would prefer to have surgery to get any remainder out and know the avm would be gone for the rest of my life. I am having two rounds of gk starting in April 2012 (I think!) I was kind of hoping for craniotomy, more for the reason that it would be removed and no more worries but unfortunately it is not an option for me.
A Collins, dr's seeem to change there minds constantly! I am feeling a little "out of loop" as my neuro told me by letter I needed GK and surgery was not a safe option, I then have to fly to NZ's South Island to get the GK done as it is the only place here in NZ that does it, so havent really had a chance to discuss anything about it with anyone!! THanks for yr responses :)
Jill--part of it is that they change their minds based on updated and/or better scans. When I had only had a CT & MRI, but hadan't had an angiogram yet, it looked like surgery might be my best option. After the angiogram, though, GK became a better option.
Also, things may look different once the start.
When I had my first GK treatement, my surgeon said he was concerned about an aneurysm I had developed & wanted me back in his office soon afterwards to discuss it. He showed us the MRI & angio scans fromt he day of the GK & how it wouldn't be a good candidate for embolization based on size & shape. It was actually more likely to rupture than the AVM, so we scheduled a craniotomy to clip the aneurysm. When they opened my head up to clip it, they found another aneurysms that was hiding in the scans--that was at great risk of rupturing. He took care of both aneurysms while he had my head open.
Now that I've had both--I'd much rather have another GK than another craniotomy, esp. since a crani for my AVM could lead to loss of left field of vision. I'm a reading teacher, so I kind of need to be able to see. I realize that I'm one of the lucky ones--no bleeds, no deficits, no seizures--"just" migraines. I've always had headaches, then the migraines started when I was a teenager, so they are my "normal."