I have a small moderate flow, right temporal AVM of approximately 2cm size. Some doctors are advising Gamma Knife while some are advising embolization. I am confused and scared. Which one is better and particularly more safe? How do I decide which doctor to go to? Gamma knife surgeon or Neuro interventionist for embolization. Anyone from experience, pls help or share contact details of doctors who can give helpful unbiased opinion.
Welcome to our community! We have a wide rage of experiences here so might be able to pass along some that help, or at least give you things to consider when making your decision. My choice was Gamma knife or craniotomy with my neurosurgeons recommendation of gamma knife. I went with Gamma knife, with success in obliterating my left temporal AVM . It did take about two years to reach the end result.
I was very happy with the result, but the waiting was difficult. As time passed the waiting became less and less a factor. I don’t have experience with embolization, but do think things to consider are the time to success, or anticipated success. Least risk of side effects? I was very comfortable with my neurosurgeon and that made the decision and his recommendation much easier.
I imagine we will hear from some others and some folks have had both procedures. For me it was being at peace with the decision based on a number of factors, risk, likelihood of success, and comfort as noted. Take care, John.
Welcome to the community,
Personally, I had an embolization - I did not have a choice due to hemorrhaging before it was found
It’s a tough decision - to say the least
Embolization seems to be front line treatment here in the US, or at least here at Barrow Neurological Institute. They do their best to cure it on the first run.
Mine took on the 1st try - 100% occlusion was achieved - I feel so blessed that it has
I have done countless hours on research of embolizations.
This is the latest I have found: Outcomes After Onyx Embolization as Primary Treatment for Cranial Dural Arteriovenous Fistula in the Past Decade - PubMed
The thing about embolizations & maybe everything in this line of work - is how skilled is the hand performing the procedure
GL to you! I am no medical professional & learned everything from what actually experienced + all the follow reading I have done
I can share my experience and maybe it’ll help! Although every situation is very different. I had planned an embolization first, but after the first attempt I reacted badly to it.
Plan B was gamma knife. I went through with it and it gave me a wholeeee lot of brain edema/swelling. (My avm was 4x4cm.) I had formed seizures 7 months after my 3rd dose.
Even though I’m on anti-seizure meds and will be for a few years, my avm is gone!! I found out last week when I had an angiogram done to prepare for a craniotomy. We thought we would need to remove the avm to prevent a brain bleed. Now I don’t need surgery!
Downside is I’m left with untreatable brain edema and seizures. But I’m happy that at least my avm was obliterated. I wish you luck on your journey and I hope whichever you choose works out for you 
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Hi! I have not had an embolization but gamma knife 3 times, a craniotomy, a shunt and a shunt revision, as well as appendectomy, gall bladder removal, and a few other minor surgeries. I don’t know the extent of sedation or recovery but I hope you have a swift recovery and successful embolization.
Well, I think the guys have set out a bit about both sides of the equation. Either treatment has its own benefits and risks.
Embolisation can be used where a fine tube (a catheter) can be successfully threaded through each of the arteries to reach the AVM and then glue or coils or other blocking materials are used to bung up the AVM, removing the pressure from your veins.
Gamma knife is also used but is especially useful where the arteries are inaccessible with a catheter – for example a catheter cannot travel along an artery that is too small to fit. So it can be used to zap the smaller arteries.
Embolisation carries the risk of dropping a blob of glue in the wrong place or tearing an artery with the guide. It can also give trouble at the catheter insertion point, usually at your groin or wrist.
Gamma knife carries the risk of zapping slightly more brain than is targeted and, as others have stated, giving rise to oedema.
Both will subject you to a decent amount of radiation in order to identify the position and layout of the AVM. It seems to me that people are subject to more radiation with an embolisation as we’ve had a few people lose their hair temporarily but that could be a risk for both, I’m not sure.
Embolisation reduces the risk of a bleed very quickly, though I’d say it isn’t a “quick fix”: it took me a long time to feel well after my embolisation. Gamma knife takes a couple of years or so to do its work.
It’s always a difficult choice. Discuss with the doctor whether they think one or the other will be more effective for your AVM or make your choice based on which you’re more comfortable with.
Hope these thoughts help.
Best wishes,
Richard