Document Detail


Combined management of intracranial arteriovenous malformations with embolization and gamma knife radiosurgery: comparative evaluation of the long-term results.
MedLine Citation:
PMID:  18291487     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Volume reduction of large AVMs attained with endovascular embolization can be potentially helpful for their subsequent radiosurgical management. The objective of the present retrospective analysis was comparative evaluation of the long-term outcome after GKR for intracranial AVM performed with and without initial embolization of the nidus. METHODS: The long-term outcome in 15 patients with intracranial AVM treated with initial embolization and subsequent GKR was evaluated and compared with the series of 237 patients treated during the same period solely with GKR. All patients were followed at least 2 years after radiosurgery. RESULTS: Mean reductions of the nidus volume and score of the radiosurgery-based grading system for AVMs after embolization constituted 6.9 +/- 2.4 mL and 0.7 +/- 0.2, respectively (P < .001). Complete obliteration of the nidus after GKR was marked in 10 cases (67%). It was attained in 9 (90%) of 10 AVMs with postembolization nidus volume less than 12 mL, and in 1 (20%) of 5 with postembolization nidus volume more than 12 mL (P < .05). Delayed cyst formation was met once (7%). Obliteration and long-term morbidity rates did not differ significantly in patients treated with and without preradiosurgical nidus embolization, whereas nidus volume was seemingly larger in the former cohort. CONCLUSIONS: Combined management with embolization and GKR may be effective for selected cases of large intracranial AVM. Radiosurgery preceded by partial nidus embolization does not associate with increased rate of long-term complications.
Authors:
Masahiro Izawa; Mikhail Chernov; Motohiro Hayashi; Hiroshi Iseki; Tomokatsu Hori; Kintomo Takakura
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Publication Detail:
Type:  Case Reports; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-03-04
Journal Detail:
Title:  Surgical neurology     Volume:  71     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-16     Completed Date:  2009-03-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  43-52; discussion 52-3     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo 162-8666, Japan. mizawa@nij.twmu.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebral Angiography
Embolization, Therapeutic / adverse effects,  methods*
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / radiography,  surgery*
Male
Middle Aged
Radiosurgery / adverse effects,  methods*
Retrospective Studies
Treatment Outcome
Young Adult

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


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