My decision to have neurosurgery was both an emotional and an analytical one.  As a physician in training, I spent hours reading about the various treatment options and was drawn to surgery by its definitive nature. In the end, though, it was confidence in my surgeon that made surgery right for me.

I had neurological symptoms since early childhood, but was not formally investigated until early on in my medical training.  It was horrifying to learn that the constant “whooshing” in my ears, left-sided weakness and intense headaches were in fact a Spetzler-Martin grade III arteriovenous malformation (AVM) nudging up on my left motor cortex.  I had to have an angiogram before my surgical consult and was blown away by the cluster of vessels that appeared as the dye ran through my brain.  At that moment, I knew that something would have to be done about the AVM.

In my first neurosurgical consult, we discussed the options: surgery, combination therapies and watchful waiting.  Embolization in combination with surgery was not ideal.  I knew that embolization could de-stabilize the lesion and be cumbersome for my surgeon.   Radiation, given the size of my AVM was not realistic.  For me, watchful waiting was impossible.  As an avid Nordic skier and hiker, I found myself increasingly worried on my long outdoor excursions and was too nervous to fly long distances for vacations.  Similarly, with every severe headache, I found myself wondering, “is this it, the fatal bleed?”

Treatment planning also involved some knowledge of the probabilities.  I knew that AVMs bleed spontaneously at a rate of roughly 2 to 4% per year.  If an AVM does bleed, it imparts a 50% morbidity/mortality.  I compared this to surgery, which imparted a 10-20% risk of hemiparesis.  Given my age, I chose surgery with its higher initial risk up front rather than a smaller risk accrued over the years.

My surgeon gave me and my family the confidence we needed to make the right decision for us.  At the time, I had not yet read the plethora of literature that my surgeon had authored, but I mustered the courage to ask him whether he was the best surgeon for the job, or whether I should travel to an “AVM center”.  He was not at all offended by my question and answered thoughtfully that he too had pondered this and discussed my case with colleagues.  I learned that there was no AVM-centre per se and that the post-operative care offered at our centre was very strong.  This gave me confidence to proceed with surgery.

Despite a long road to recovery, I do not regret my decision and have accepted the new challenges that life has offered me.