Angiogram Results- Can Anyone Explain?

Hello fellow AVM’ers! Anyone on here good at translating medical talk into plain English? We’ve decided to treat it with embolization and resection surgery (craniotomy) a day or two later. The plan is to get me in asap, early December. Unruptured but increased seizures, memory, visual and language deficits, balance, etc. And based on the findings (below), an incidental carotid anyeursm :grimacing:

Findings: There is a left posterior temporal brain AVM. The AVM nidus measures approximately 2 cm in diameter. The AVM is supplied by posterior temporal branches of the mildly enlarged left posterior cerebral artery. There is also recruitment from posterior temporal and angular branches of the left middle cerebral artery. There is no
dural supply. The AVM is drained by an enlarged superficial collector which bifurcates and drains posteriorly into the left transverse sinus and anteriorly via an enlarged superficial cortical vein which drains via the cavernous sinus. Dural sinuses are widely patent. Draining veins are widely patent apart from possible narrowing of the draining vein as it enters the left transverse sinus. No nidal or perinidal aneurysms are seen and there is no evidence of an aneurysm along the AVM feeding arteries. There is an
incidental 3 mm aneurysm arising from the proximal left cavernous segment of the internal carotid artery, within the cavernous sinus. No other cerebral aneurysms. Dural sinuses are widely patent. Neck vessels are widely patent.
Conclusion: Spetzler-Martin Grade II left posterior temporal brain AVM.
Incidental 3 mm proximal left cavernous internal carotid artery aneurysm.

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If you tell me which words you don’t understand, I can happily translate a little. Most of it is simply describing where it is.

“Patent” means free flowing, not having any blockage.

My AVM did have dural involvement (so far as I understand it) the dura mater is one of the meningeal layers over the brain: yours seems to be not dural and I, too, had it discharging into my transverse sinus (and a narrowing of the transverse sinus) which led on to me hearing the whoosh, whoosh noise of it at night. I also had some dizziness or oddness.

“Bifurcation” means it splits into two vessels and so you have two draining routes, though I don’t know anatomy well enough to know where that second route goes and what effects it could be having.

Any other parts you need help with?

Let us know when you are going in and we can wish you luck, cross fingers and toes, say prayers or whatever you need to help you along the way.

Lots of love,

Richard

Thanks Richard! I was diagnosed end of June and I’ve been somewhat ‘obsessed’ with wanting to understand everything about my AVM. Im a bit (okay a lot) of a control freak, and this has sent me into a whirlwind of anxiety, not the AVM itself, rather the wanting to understand and know everything (treatment, dates, etc.).

Initially based on my MRI, my neuro team reccomend Gamma Knife, surgery was quite risky. But after having my angiogram, they reccomend embolization and surgery, and asap. But I wasn’t given a lot of details, and I didn’t ask a lot of questions because I was shocked that surgery was now not only an option but the recommendation. It’s what I wanted all along, just get’er done.

So all of that to say, I was hoping based on my Findings, someone here could provide me with a little insight. Like, is this a run of the mill AVM, simple or complex, etc. Your feedback was greatly appreciated :pray:

And yes, as soon as I get the ‘call’ with an admission date, I’ll be sure to share. I’m more anxious about the logistics, then I am with the actual surgery.

I know what you mean! I consider myself an analyst and my coping mechanism was to understand what this was all about in a similar way. Honestly, I found about half the stuff I learned about through people’s stories to encourage me and about half of it frightened me! Overall, learning about it helped me to rationalize what was ahead. The road had suddenly branched off into a dark and foreboding valley but the rationalisation helped me realise I had no choice to travel a different way, the only way was to keep walking through and choose one of the paths that led out the other side.

I can’t tell you anything about the anatomy in a way that should encourage you or discourage you with the approach: I wouldn’t dare to do so.

What I can tell you is that it doesn’t seem unusual for the docs to refine their approach once the angiogram is done. (In my mind, this is exactly why the angiogram is valuable: it sets out the vasculature in much clearer detail than an MRI. It is much more invasive a process than the MRI but gives a much clearer view of arteries and veins). So I’m not sure that I would be perturbed by the change in plan in that way.

Did the doc set out the risks associated with the two approaches? It sounds like they’re no longer recommending the radiosurgery route, so may not have described the risks of one versus the other. However, really the only choice you have is which set of risks you’re most ok with. I see three sets of risks for you:

  1. The embolisation + surgery set
  2. The radiotherapy set or
  3. The “do nothing” set.

If 2 is off the cards, then you just need to satisfy yourself between 1 and 3. My DAVF was busy changing monthly, so I was very easily convinced that (in my case) just an embolisation was needed – the only route offered to me – to get me back on the straight and narrow.

I can tell you that embolisation + surgery is a common approach. The idea of the embolisation is to block off the flow so that you bleed less during the surgery. This is designed to improve your outcome: less rupture during the craniotomy, or less risk of an uncontrolled rupture. It seems a much better idea than without.

Many, many people have this approach and it seems to be at least as successful as any other approach. That yours is graded “II” indicates that it perhaps isn’t too deep or treading into your core capabilities. In this way, it seems in line with operations others have had. Higher grading indicates a higher than average risk of trouble from the operation. You can read more about the grading system in the AVM101 category on this site. I assume yours does have some deep drainage but isn’t in an “eloquent” area of the brain (= core capabilities).

I hope something I splurge out might help.

I wish you all the best with making your mind up and getting through the process. None of us find it easy at all. It is very much new, untrodden roads for us, until you’ve had to walk that way.

Richard

Again, thank you for your response, it makes sense. And I have already decided on Embolization+surgery, we discussed the risks and they are risks I’m willing to take.

I could receive the call for an admission date any day now!

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I was both excited and frightened at this stage.

I have to say that having gone through an embolisation successfully, I felt I knew what it felt like (basically I was worried about the risks but also about pain: would I cope?) and the easy answer is that the drugs are great. I had a sore head but my embolisation was much more gettable-throughable than I had thought.

I expect you feel the same.

I hope you get a date soon and I hope it goes just :star2::star2::star2::star2::star2:

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Hi Phoenix! I also had embolization + surgery this summer. Good luck to you, everything is gonna be alright, stay positive!

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