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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Gamma Knife surgery for large cerebral arteriovenous malformations
Hae Yu Kim1, Won Seok Chang, Dong Joon Kim
1Department of Neurosurgery, Inje University College of Medicine, Busan, Korea.
Journal of Neurosurgery
|December 3, 2010
Summary
Repeat Gamma Knife surgery (GKS) offers an acceptable complication rate for treating large arteriovenous malformations (AVMs). Long-term follow-up shows a respectable obliteration rate, making repeat GKS a viable option for large AVMs.
Area of Science:
- Neurosurgery
- Radiation Oncology
Background:
- Arteriovenous malformations (AVMs) present significant treatment challenges due to size, location, and potential complications.
- Large AVM nidus volume (> 30 cm³) poses a limitation for successful treatment with conventional methods.
Purpose of the Study:
- To evaluate the efficacy and safety of repeat Gamma Knife surgery (GKS) for treating large AVMs (> 30 cm³).
- To analyze AVM obliteration rates and complication profiles following repeat GKS.
Main Methods:
- Retrospective review of 44 patients with large AVMs treated with GKS between 1992 and 2007.
- Mean nidus volume was 48.8 cm³, with a mean marginal dose of 13.9 Gy.
- Repeat GKS sessions were performed at minimum 3-year intervals if initial treatment did not achieve obliteration.
Main Results:
- Overall obliteration rate after repeat GKS was 34.1%, with an estimated 120-month obliteration rate of 41.8%.
- Hemorrhage occurred in 6.8% of patients, cysts in 4.5%, new seizures in 2.3%, and radiation necrosis in 2.3%.
Conclusions:
- Repeat GKS achieves acceptable complication rates for large AVMs, despite a prolonged time to obliteration.
- The long-term obliteration rate is respectable, supporting repeat GKS as a primary treatment option.
- Repeat GKS helps overcome the challenge of large nidus volumes in AVM treatment.
