Hi Phoenix and Chris,
Firstly Phoenix I hope they deem you a suitable candidate for gamma. I remember being in exactly the same boat, surgical options very risky and I was hugely disappointed by this. But I was a suitable gamma candidate and 4.5 years down the road I will find out in November whether it has worked!!
My situation was also very similar to yours. I was diagnosed after my rupture in 2019, right occipital SM grade 4. Surgery was deemed 40% likely to cause motor or vision deficits due to location, depth and configuration of the AVM.
I am VERY INTERESTED in your experiences of focal seizures. I was never asked about this, but in the 3-4 years leading to my bleed I had what I felt were panic attacks at the time. I have never associated them with my AVM. They happened exclusively at times of high stress and usually when I was speaking/presenting in front of groups. It was like I had lost the ability to speak or move for just a few seconds in reality, but felt like a lifetime…time moved very slowly, I had visual auras and then felt absolutely exhausted afterward. Can you describe your focal seizures? Were they anything like this? I am on no medication and haven’t had one since my bleed, although my work related stress has also been far lower since then.
Chris and Dick, there is evidence from published studies suggesting that embolisation materials may affect the efficacy of gamma knife. My gamma knife surgeon was anxious to ensure that I was not embolisms during the acute phase post bleed, and my consultant neurosurgeon who oversees my care said that he often uses embolisation as a precursor to surgical resection but never prior to gamma knife for this reason. If you search for the studies or just Google ‘embolisation before game knife for AVMs’ I am sure you will find the relevant studies.
Best of luck.
Jonny