Can grade 5 AVM in middle cerebral artery progress?

Question

Hello doctor,

My spouse was diagnosed with a cerebral aneurysm six years ago. He got imaging done after two years, where they diagnosed a grade 3 Spetzler Martin (AVM (arteriovenous malformation) in a left middle cerebral artery, eloquent with deep drainage. He has right-sided hemiparesis as a result and some difficulty solving complex problems. Four years later, he had another study read as grade 5 Spetzler Martin classification.

He is only 33 years old and does not appear to have worsening symptoms other than more frequent headaches (not every day). He usually has low blood pressure 90 to 100 mmHg). However, when he has headaches, he has had SBPs of 150 to 180 mm of Hg and DBP (diastolic blood pressure) of 100 mm of Hg.

He does have a history of testicular cancer for which he received chemotherapy and had a testicle removed eight years ago. Since then, he has had cold intolerance and reports having issues with gaining weight most of his life, even with adequate food intake. With his culture, he eats several tortillas daily and usually has at least one to two cans of soda per day (approximately one liter, but usually a little less).

He does not drink coffee or other caffeinated beverages and drinks between one and two liters of water daily. I am concerned because I have read that grade 6 is inoperable, and I want him to seek treatment as soon as possible if it is still indicated and beneficial.

I have his images from last year on a CD, but I am not sure I could find a neurosurgeon to evaluate them for an opinion. Any insight would be most appreciated.

Please guide.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I have reviewed the reports (attachment removed to protect the patient's identity). Yes, it is a high-grade AVM (arteriovenous malformation) and is diffuse. I would suggest Gamma Knife radiosurgery (fractionated) for your spouse, which is the only feasible and safest option.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern. I could not see an arterial aneurysm, but a venous aneurysm or varix exists. The chances of rupturing a venous aneurysm are relatively lower than those of an arterial aneurysm if there is a feeder artery aneurysm, that should be treated as it is more likely to rupture.

A venous varix will gradually disappear once the AVM (arteriovenous malformation) starts shrinking after treatment. Such high-grade AVM, when unruptured, has a relatively safer natural history than when treated with embolism or surgery, so it is better not to be treated by that. But, in this case, Gamma Knife radiosurgery should help.

I hope this helps.

Thank you and take care.