The Challenge: Arteriovenous Malformation (AVM)
Most afternoons, you'll find Cindy Orlandini walking her beloved golden retriever, Buddy. Her longtime partner, Christopher, often walks along where they live together in Green Tree, Pa., a suburb of Pittsburgh.
Cindy is 43 years old and values life's simple pleasures — a perspective given shape by her long and sometimes life-threatening health problems.
“Every time I see [my surgeons], I tell them they saved my life." — Cindy
When she was just 23, Cindy was in a car accident in Washington, D.C.
The wreck fractured the left side of her face, near her eye. Following the accident, Cindy underwent an MRI at a nearby hospital. It was there that doctors found an arteriovenous malformation (AVM) filling the left frontal lobe of Cindy's brain.
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An AVM is a congenital defect (present at birth).
It affects the connection between arteries and veins, disrupting the flow of blood between them. It is an abnormal, berry-like nest of blood vessels that can burst, causing strokes and severe brain damage if left untreated.
Doctors performed what would be the first of many embolizations to keep Cindy's AVM from rupturing and causing serious bleeding.
An embolization is a technique in which doctors:
- Thread a small catheter or tube through a blood vessel in the groin.
- Guide the tube to blood vessels in the brain and inject material called an embolic agent.
The embolic agent tries to reduce or block the flow of blood throughout the AVM's nest of blood vessels.
Despite many embolizations, Cindy's AVM remained about the size of an orange.
The Path to UPMC for AVM Care
By 2013, Cindy's condition got dangerously worse. She was working as a dental assistant and usually left the house at 10:30 a.m. to go to work.
One morning, Christopher took time off from his own job to get the oil changed in his car. When he came back a few hours later, he was surprised to see Cindy's car still in the driveway.
“I thought, well, she's probably on her way out so I'll see her when she's leaving," Christopher says.
But when he went in the house, Cindy was still in bed. Christopher roused her, but she seemed disoriented as she put on her scrubs, got in the car, and left.
Christopher told Cindy to text him when she reached her office, but a half hour went by with no word from her.
Growing concerned, he called her. She answered the phone, confused.
“Long story short, she was in a parking lot right up the street from our house. She didn't know where she was going," Christopher explains.
He went right away to bring her home, but she wasn't speaking normally. She was jumbling her words in a way he'd never heard before.
“I said, 'let's go,' and I took her immediately to UPMC Presbyterian," he says.
Christopher grew up nearby and trusted that Cindy would be in good hands in the care of their doctors.
When they got to the ER, doctors swiftly came to Cindy's aid. It turned out that Cindy's odd behaviors were symptoms of a major bleed in her brain caused by the AVM.
“It was a miracle that I didn't go to work that morning and got an oil change instead," Christopher says. “The doctor told us that if we had waited any longer to get help, she would have likely passed away."
The Solution: Expert Treatment and Technology at UPMC
Cindy was soon in the hands of UPMC neurosurgeons Robert M. Friedlander, MD, and L. Dade Lunsford, MD.
Both Drs. Friedlander and Lunsford told Cindy that she had one of the biggest AVMs they had encountered in their respective careers.
Before Dr. Friedlander could perform a craniotomy to remove the AVM, Dr. Lunsford needed to shrink it. To do so, he performed Gamma Knife® radiosurgery on Cindy.
Gamma Knife radiosurgery is one of the most precise, powerful, and proven treatments for brain disorders like AVMs.
With no incision required, this painless technique uses hundreds of highly focused radiation beams to target and shrink brain tumors and lesions. In the case of treating AVMs, the goal is to lead to gradual shrinkage of the abnormal blood vessels.
In 2015, after some rounds of Gamma Knife treatment, Cindy's AVM was small enough for Dr. Friedlander to remove it via craniotomy.
The Results: Getting Better Each Day
While Dr. Friedlander fully removed her AVM in 2015, a new complication arose for Cindy. By 2018, a slowly expanding blood clot had filled the area where the AVM had been.
Fortunately, Dr. Friedlander was able to safely remove it by performing another craniotomy.
Since her surgeries, Cindy returns for yearly MRIs and check-in appointments with Dr. Friedlander and Dr. Lunsford.
Since her second craniotomy, Cindy has had no further issues.
Because of the effects of her first major brain bleed in 2013, Cindy has trouble with short-term memory. She's also lost some motor function.
“I used to have the most beautiful handwriting," she says. “Now, you can barely read it."
“But she’s practicing it every day,” Christopher chimes in. “And each day, it gets better than the last. That’s the thing about Cindy. She has such a positive attitude. Her personality and her faith are what really pulled her through."
Cindy, however, cites Christopher as the rock that grounded her through her tumultuous experience. She is also extremely grateful for her surgeons, Dr. Friedlander and Dr. Lunsford.
“Every time I see them, I tell them they saved my life,” she says.
Christopher agrees.
“I could have taken Cindy anywhere in Pittsburgh for treatment, but I chose UPMC because I knew that everything would fit together like a puzzle,” he says.
"And now, we do brain puzzles every day to help me get better,” Cindy laughs. “I’m in a good place now."
Our patient stories profile a number of patients who have had minimally invasive brain surgery at UPMC. Although everyone's care experience is unique, we hope that sharing these stories will help other prospective patients and their families better understand these procedures and their potential benefits.
Cindy’s treatment and results may not be representative of all similar cases.
