There are only two or three neurosurgeons who operate on AVM’s at Mayo and they cannot seem to agree on the best course of action for me. Therefore, we are in no rush to make a quick decision about which route to take.
Dr. F.B. Meyer, the head of neurosurgery seems to think that I would be best served by the traditional intercranial surgery which entails physically going in after this thing. This approach, following surgery, would involve at least two days in Intensive Care and five days of hospitalization afterward. He explained that this approach has a 100% success rate….that is, they always get the AVM out. Oh yes, but there are also very real and serious complications in about 18% of cases (this number seems to vary from day to day).
The upside with this approach is that you know where you’re at soon after surgery. You’re either good and everyone’s happy, good with some temporary short term deficits with fine motor skills like language or right side body movement that can be regained, not so good with a serious lifetime deficit that cannot be regained, or worse. Again, if we do the math and say there is a 61% probability of this thing bleeding some time in my life if we do nothing, versus a one time risk of up to 20% long term deficit….well you can see the conundrum…can’t you? On Wednesday Dr. Meyer pretty much had us convinced that this was the route to take. However, he then referred us for a consultation with his partner Dr. Pollock.
We met with Dr. Pollock today for about 45 minutes. We liked him and his demeanor. Dr. Pollock is the world’s leader in a relatively new and innovative approach to treating larger AVM’s with radio surgery…or the gamma knife. The gamma knife isn’t really a knife, but rather focused radiation (radioactive cobalt) in exact areas of the AVM. They have done radiosurgery like this at Mayo since 1990.
Dr. Pollock, however, has pioneered this new approach call “staged radio-surgery” whereby the AVM is divided up into 2 or 3 parts and blasted with radioactive stuff. It is treated on 2 or 3 separate occasions with one to three months in between treatments. The plus side of this is that there is only a 5% risk of serious problems with this approach. The downside is that it has only about a 40% obliteration rate, with varying degrees of success possible as well. Talking with Dr. Pollock made us seriously consider the possibility of not doing anything. After all, life is now good! I would be very happy to live the rest of my years with all of the deficits I was born with, without adding a one! Both Drs. were in agreement: There are lots of ways neurosurgeons can hurt people.
The main downside to this “staged radio surgery” as I see it is that he has only done 25 of them in the past 11 years (and he’s the only one who does them at Mayo) at one of the premier medical centers in all the world. In these same 11 years there have been 550 AVm’s treated at Mayo. I’ve always kind of liked guinea pigs but at the same time I’ve always felt a little bad for them. Dr. Pollock thinks I am a good candidate for this approach because of the size, density, and location. When I asked him if he would recommend this for his own son he seemed to dodge the question.
When Dr. Meyer called on my cell phone today I asked him if he would be talking my case over with Dr. Pollock. He assured me that he would. I don’t know how neurosurgeons go at it when wrestling through their differences…maybe they just pull out various standardized test scores along their journeys and try to gain the upperhand in that way. I expect Dr. Meyer to give me a call tomorrow. I think I’d rather talk to the repair shop guy again…about anything but this.