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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Clinical and pathological changes in cerebral arteriovenous malformations after stereotactic radiosurgery failure
Wei-ming Liu1, Xun Ye, Yuan-li Zhao
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Background:
Stereotactic radiosurgery is an alternative to resection of intracranial cerebral arteriovenous malformations (AVMs), while it will fail in some cases. This study aimed to evaluate the changes after stereotactic radiosurgery for AVMs.
Methods:
Nineteen cases with cerebral AVMs had failure after stereotactic radiosurgery therapy. The symptoms and angiography were assessed. All patients underwent microsurgery. Pathologic examination was performed for all cases and electron microscopic examination was carried out in 6 patients.
Results:
Seven cases had hemorrhage from 12 to 98 months after stereotactic radiosurgery, 5 had headache, 4 had refractory encephalon edema, 2 had epilepsy as a new symptom and 1 had a pressure cyst 5 years after radiosurgery. Angiography in 18 cases, 8 - 98 months after radiation therapy, demonstrated no significant changes in 5 cases, slight reduction in 9, near complete obliteration in 1 and complete obliteration in 3. An abnormal vessel was found on pathologic examination in 17 cases, even one case had obliterated in angiography. Electron microscopy examination showed vessel wall weakness, but the vessels remained open and blood circulated. One case died because of a moribund state before surgery. The other 18 cases had no new neurological deficiencies, seizure control and no hemorrhage occurred after microsurgery at an average follow-up of 3 years.
Conclusion:
Stereotactic radiotherapy for AVMs should have a long period follow-up. If serious complications occur, microsurgery can be performed as salvage treatment.
Insights
Stereotactic radiosurgery for brain arteriovenous malformations (AVMs) can fail, requiring long-term follow-up. Microsurgery serves as an effective salvage treatment for AVMs with serious complications post-radiosurgery.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Stereotactic radiosurgery (SRS) is an alternative to resection for intracranial cerebral arteriovenous malformations (AVMs).
- SRS therapy can fail in a subset of patients with AVMs.
- This study evaluates outcomes following SRS for AVMs.
Purpose of the Study:
- To assess the clinical and radiological changes in patients with cerebral AVMs after failed stereotactic radiosurgery.
- To determine the efficacy of microsurgery as a salvage treatment for these cases.
Main Methods:
- Retrospective analysis of 19 patients with cerebral AVMs who experienced treatment failure after SRS.
- Assessment of patient symptoms and angiographic findings.
- All patients underwent microsurgery, with pathological and electron microscopic examination in select cases.
Main Results:
- Complications observed post-SRS included hemorrhage, headache, edema, new-onset epilepsy, and cysts.
- Angiography showed variable AVM response, with complete obliteration in 3 cases.
- Pathological examination revealed persistent abnormal vessels in most cases, with electron microscopy showing vessel wall weakness.
- Microsurgery resulted in no new neurological deficits or hemorrhages in 18 patients at a 3-year follow-up.
Conclusions:
- Long-term follow-up is crucial for patients undergoing stereotactic radiotherapy for AVMs.
- Microsurgery is a viable salvage option for managing serious complications arising after SRS for AVMs.
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