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Stereotactic radiosurgery of arteriovenous malformations: pathologic changes in resected tissue
S D Chang1, D L Shuster, G K Steinberg
1Department of Neurosurgery, Stanford University School of Medicine, California, USA.
Clinical Neuropathology
|March 1, 1997
Summary
Stereotactic radiosurgery can induce vascular changes in arteriovenous malformations (AVMs). Higher radiation doses correlate with more severe changes, suggesting a dose-response relationship for AVM treatment.
Area of Science:
- Neurology
- Radiation Oncology
- Pathology
Background:
- Arteriovenous malformations (AVMs) are treated with stereotactic radiosurgery (SRS) and microsurgery.
- Multimodality treatment combining SRS and microsurgery is increasingly used for AVMs.
Purpose of the Study:
- To investigate the pathological changes in AVMs following SRS.
- To determine the correlation between radiation dose and the extent of radiation-induced changes in AVMs.
Main Methods:
- Surgical resection of 33 AVMs from patients previously treated with SRS.
- Pathological evaluation of resected AVMs for specific radiation-induced changes (endothelial proliferation, vascular wall changes, thrombosis, necrosis).
- Correlation analysis between radiation dose (GyE) and semiquantitatively assessed radiation-induced changes.
Main Results:
- Significant correlation (r = 0.624, p < 0.01) found between radiation dose and extent of pathological changes.
- No absolute radiation dose threshold below which changes were absent.
- Patients receiving >20 GyE showed moderate to severe changes; those >30 GyE had severe changes.
Conclusions:
- Radiation-induced changes in AVMs after SRS are dose-dependent.
- Understanding this dose-response relationship may help optimize SRS protocols for AVM treatment.