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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Stereotactic radiosurgery after embolization for arteriovenous malformations.

Hideyuki Kano1, Douglas Kondziolka, John C Flickinger

  • 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.

Progress in Neurological Surgery
|December 22, 2012
PubMed
Summary

Prior embolization before stereotactic radiosurgery (SRS) for arteriovenous malformations (AVM) did not affect hemorrhage risk but reduced obliteration rates. Further research is needed on embolization after SRS.

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Vascular Neurology

Background:

  • Arteriovenous malformations (AVMs) pose significant risks, including hemorrhage.
  • Stereotactic radiosurgery (SRS) is a treatment option for AVMs.
  • The role of prior embolization in conjunction with SRS for AVMs requires further elucidation.

Purpose of the Study:

  • To evaluate the long-term benefits and risks of SRS for AVM patients who previously underwent embolization.
  • To compare obliteration rates and hemorrhage risks between AVM patients treated with SRS alone versus those treated with embolization followed by SRS.

Main Methods:

  • Retrospective analysis of 120 patients with AVM treated with Gamma Knife® SRS after embolization (1987-2006).
  • Assessment of obliteration rates via angiography or MRI, and analysis of hemorrhage events and neurological deficits.
  • Case-match control technique to compare outcomes with SRS alone.

Main Results:

  • The overall obliteration rates at 10 years were 59%.
  • Hemorrhage occurred in 8% of patients during the latency interval, with a 7.7% 10-year actuarial rate.
  • Prior embolization was associated with a lower total obliteration rate (p=0.028) but did not significantly affect hemorrhage risk.
  • Permanent neurological deficits from adverse radiation effects occurred in 2.5% of patients.

Conclusions:

  • Prior embolization in AVM patients undergoing SRS reduces the rate of total obliteration.
  • Hemorrhage risk during the latency interval is not significantly affected by prior embolization.
  • The potential role of embolization after SRS warrants further investigation.