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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Radiosurgery for large cerebral arteriovenous malformations.
Seung-Yeob Yang1, Dong Gyu Kim, Hyun-Tai Chung
1Department of Neurosurgery, Dongguk University College of Medicine, Goyang, Gyeonggi-do, South Korea.
Acta Neurochirurgica
|February 12, 2009
Summary
Radiosurgery shows promise for treating large arteriovenous malformations, achieving obliteration in some cases and maintaining low annual hemorrhage rates. This technique is a viable alternative for patients with larger AVMs.
Area of Science:
- Neurosurgery
- Radiation Oncology
Background:
- Radiosurgery is effective for small to medium arteriovenous malformations (AVMs).
- Larger AVMs (>14 cm³) have historically shown lower obliteration rates with radiosurgery.
- This study investigates radiosurgery's efficacy in large AVMs.
Purpose of the Study:
- To assess the applicability and effectiveness of radiosurgery for large arteriovenous malformations.
- To evaluate obliteration rates and hemorrhage risk after radiosurgery for large AVMs.
- To determine the impact of embolization on radiosurgery outcomes for AVMs.
Main Methods:
- Retrospective study of 46 patients with AVMs >14 ml treated with radiosurgery (linear accelerator and gamma knife).
- Patients grouped by presentation (hemorrhage vs. no hemorrhage) and embolization status.
- Retreatment with gamma knife for incomplete obliteration after 3-year follow-up.
Main Results:
- Mean treatment volume was 29.5 ml; mean marginal dose was 14.1 Gy.
- Complete obliteration achieved in 11/33 patients after first radiosurgery and 3/4 after second.
- Preradiosurgical embolization increased hemorrhage risk in the non-hemorrhage group (HR 28.03, P=0.039).
- Latency period hemorrhage occurred in 8/25 patients with embolization vs. 0/21 without (P=0.004).
Conclusions:
- Radiosurgery can be a safe and effective treatment for large arteriovenous malformations.
- It offers a potential alternative treatment option for complex AVM cases.
- Careful consideration of embolization is needed due to increased hemorrhage risk in certain patient groups.
