Document Detail


Clinical and neuroimaging outcome of cerebral arteriovenous malformations after Gamma Knife surgery: analysis of the radiation injury rate depending on the arteriovenous malformation volume.
MedLine Citation:
PMID:  18671629     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: In this paper the authors analyzed the clinical and neuroimaging outcomes of patients with cerebral arteriovenous malformations (AVMs) after Gamma Knife surgery (GKS), focusing on the analysis of the radiation injury rate depending on the AVM volume. METHODS: Between 1997 and 2004, 277 consecutive patients with cerebral AVMs were treated with GKS. Of these patients, 218 were followed up for >or= 2 years. The mean age was 31 +/- 15 years, the median AVM volume was 3.4 cm3 (range 0.17-35.2 cm3), the median marginal dose was 18.0 Gy (range 10.0-25.0 Gy), and the mean follow-up duration was 44 +/- 20 months. The authors reduced the prescription dose by various amounts, depending on the AVM volume and location as prescribed in the classic guideline to avoid irreversible radiation injuries. RESULTS: The angiographic obliteration rate was 66.4% overall, and it was 81.7, 53.1, and 12.5% for small, medium, and large AVMs, respectively. The overall annual bleeding rate was 1.9%. The annual bleeding rate was 0.44 and 4.64% for small and large AVMs, respectively. Approximately 20% of the patients showed severe postradiosurgery imaging (PRI) changes. The rate of PRI change was 11.4, 33.3, and 9.5% for small, medium, and large AVM volume groups, respectively, and a permanent radiation injury developed in 5.1% of patients. CONCLUSIONS: By using the reduced dose from what is usually prescribed, the authors were able to obtain outcomes in small AVMs that were comparable to the outcomes described in previous reports. However, medium AVMs appear to still be at risk for adverse radiation effects. Last, in large AVMs, the authors were able to attain a tolerable rate of radiation injury; however, the clinical outcomes were quite disappointing following administration of a reduced dose of GKS for large AVMs.
Authors:
Jung Ho Han; Dong Gyu Kim; Hyun-Tai Chung; Chul-Kee Park; Sun Ha Paek; Jeong Eun Kim; Hee-Won Jung; Dae Hee Han
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  109     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-01     Completed Date:  2008-09-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  191-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebral Hemorrhage / epidemiology,  etiology,  pathology
Dose-Response Relationship, Radiation
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / epidemiology,  pathology*,  surgery*
Magnetic Resonance Imaging*
Male
Middle Aged
Postoperative Complications / epidemiology,  etiology,  pathology
Prognosis
Radiation Injuries / epidemiology,  pathology*
Radiosurgery / adverse effects*,  statistics & numerical data
Risk Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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