This is a personal blogs of things unimportant and important (to me).

Saturday, August 11, 2007

AVM Update - Challenge of first opinion

Background
After the second opinion, which agreed with the diagnosis but differed with the treatment, the question was the need for embolization prior to Gamma Knife Radiation.
Why embolization
According to Dr Rossenwasser, size is important (at least in treating AVM's).
My AVM is small (~3 in). Ther are only two 'cures' for AVM- Surgery and Radiation Therapy (Gamma Knife). What they know is that there is a minimum radiation required to successfully destroy the AVM. The larger the AVM the additional radiation required. It is more than the size - it is about the volume and the topology of the AVM. The borders of the AVM need to radiated with enough strength to be effective.
Effectiveness of the radiation therapy is calculated by the volume to be irradiated- in my case the estimate is that given the size of my AVM I would have 70-80% success probability with a single Gamma Knife radiation.
Embolization will reduce the volume of the AVM. 6-8 weeks after embolization, radiation would be applied. Embolization reduces the size of the AVM and makes the success probability higher.
Options are to do 2 radiation procedures, spread over 12 months, in order to guarantee a much higher rate of success of the procedure.
Dr Rossenwasser was involved in the review of the paper that questioned the effectiveness of embolization prior to radiation. The way I understood his observation on this paper is that the results had to do with the strength of the radiation used in the comparative studies- very low to measure the effectiveness of radiation.

Risks

Timing
October is the first window for embolization; radiation would most probably happen after my return from Australia.
Embolization is an overnight stay at the hospital (and, based on my prior experience with catheterization, 1 or 2 days at home).
Next Steps
Discuss with Ken
Wait for Rossenwasser schedule

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