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Published on: July 21, 2013
The Thalamic Arteriovenous Malformations Have Better Prognosis than Basal Ganglia Malformations Regarding
Sergio Moreno-Jiménez1, Leonel B Alvarado-Torres2, Fabiola Flores-Vázquez3
1Radiosurgery Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Background:
Arteriovenous malformations (AVMs) are rare vascular congenital lesions that affect mainly patients during their productive years of life. In order to obtain a better quality of life for patients with this disease, a multidisciplinary approach is recommended. Radiosurgery is one of the treatment modalities available for AVMs, but many factors may influence the effectiveness of this strategy. Classically, it has been said that deep-seated lesions have a particular behavior compared with AVMs in other regions, but a differentiation between thalamic lesions and those located in the basal ganglia has not been made.
Methods:
Institutional records for central core AVMs treated with radiosurgery between January 2004 and January 2014 were retrospectively analyzed. Brainstem lesions were excluded from the analysis.
Results:
Forty-nine patients with deep-seated AVMs were included. Forty-three (87.8%) were located in the thalamus and 6 (12.2%) in the area of basal ganglia. The nidus mean volume was 4.1 cm3 (SD: 4.1), the maximum diameter mean was of 19.5 mm (SD: 8.0). The prescription dose was 18.2 Gy (SD: 2.1), and the follow-up time was 75.8 months (SD: 32.5). There was a greater obliteration rate in thalamic AVMs compared with those located in the basal ganglia: 81.4% versus 33.3% (P = 0.026), respectively. There was no association between categorical variables and obliteration rate.
Conclusions:
Stereotactic radiosurgery is a good option for patients with thalamic and basal ganglia AVMs, but a multidisciplinary approach to decision-making is mandatory in order to achieve the best results.
