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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Multistaged Stereotactic Radiosurgery for Complex Large Lobar Arteriovenous Malformations: A Case Series
Mehmet Denizhan Yurtluk1, Othman Bin-Alamer1, John C Flickinger2
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA.
Neurosurgery
|July 5, 2024
Summary
Multistage stereotactic radiosurgery (SRS) shows potential for large brain arteriovenous malformations (AVMs), but risks of hemorrhage and deficits persist during treatment. Long-term outcomes show stable or improved neurological function for most patients.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Vascular Neurology
Background:
- Stereotactic radiosurgery (SRS) is established for small arteriovenous malformations (AVMs).
- Outcomes for large-volume (≥10 cc) lobar AVMs treated with SRS are less defined.
- This study investigates SRS efficacy for complex, large AVMs.
Purpose of the Study:
- To evaluate the effectiveness of multistage Leksell Gamma Knife SRS for large-volume (≥10 cc) lobar brain AVMs.
- To assess obliteration rates, hemorrhage risk, and neurological outcomes in this patient cohort.
- To understand the long-term results of staged SRS for complex AVMs.
Main Methods:
- Retrospective analysis of 40 patients with large lobar AVMs treated with volume-staged SRS (2-5 procedures) between 1990-2022.
- Included patients with diverse AVM locations and Spetzler-Martin Grades.
- Some patients also underwent pre-SRS embolization.
Main Results:
- A 10-year obliteration rate of 53.3% was achieved in 20 patients.
- Significant risks of intracerebral hemorrhage (ICH) and new neurological deficits were observed during the latency period.
- Postoperative hemorrhage risk reached 36.2% at 10 years; no hemorrhages occurred after confirmed obliteration.
- Most patients (28/40) had stable or improved modified Rankin Scale (mRS) scores.
Conclusions:
- Multistage SRS offers potential for treating large, complex, high-risk lobar AVMs.
- The risk of hemorrhage and complications persists during the latency interval before obliteration.
- Long-term neurological outcomes (mRS) were generally favorable, highlighting a balance between treatment benefits and risks.
