Document Detail


Does hemorrhagic presentation in cerebral arteriovenous malformations affect obliteration rate after gamma knife radiosurgery?
MedLine Citation:
PMID:  18573592     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Radiosurgery has been widely adopted for the treatment of cerebral AVMs. However radiosurgical treatment of patients with hemorrhagic presentation is fraught with risk of rebleed during latency period. The present study intends to analyze the obliteration rate, time to obliteration and chances of rebleed in patients with hemorrhagic versus non-hemorrhagic clinical presentation in cerebral arteriovenous malformations (AVMs) treated with gamma knife radiosurgery (GKS). PATIENTS AND METHODS: Of all the patients with cerebral AVMs treated from May 1997 to June 2006, 157 patients with neuroimaging follow up with digital subtraction angiography harboring 160 AVM nidii formed the study group. The mean age of presentation was 28 years (range, 6-58 years); mean nidus volume being 3.64 cm3 (range, 0.011-36.6 cm3). The mean follow up period was 70 months (range, 13-121 months). All the patients were treated predominantly by primary GKS with use of adjunctive pre-GKS embolization in selected patients. RESULTS: A total of 103 (64%) patients presented with hemorrhage. There was no difference in the obliteration rate (69% versus 67%, p=0.672), mean latency period to obliteration (30 months versus 32 months, p=0.1989) and chances of hemorrhage (4.8% versus 3.5%, p=0.690) in patients with hemorrhagic as compared to non-hemorrhagic presentation. CONCLUSION: Prior hemorrhage does not affect the outcome after GKS in terms of obliteration rate, latency to obliteration as well as chances of hemorrhage during latency period. Gamma knife appears equally efficacious irrespective of the mode of clinical presentation in the management of cerebral AVMs; a concomitant use of pre-GKS embolization/surgery may be needed in patients with hemorrhagic presentation in selected cases, however.
Authors:
Manish Kumar Kasliwal; Shashank Sharad Kale; Aditya Gupta; Narayanam Anantha Sai Kiran; Manish Singh Sharma; Deepak Agrawal; Bhawani Shanker Sharma; Ashok K Mahapatra
Publication Detail:
Type:  Journal Article     Date:  2008-06-24
Journal Detail:
Title:  Clinical neurology and neurosurgery     Volume:  110     ISSN:  0303-8467     ISO Abbreviation:  Clin Neurol Neurosurg     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-27     Completed Date:  2008-11-14     Revised Date:  2009-10-14    
Medline Journal Info:
Nlm Unique ID:  7502039     Medline TA:  Clin Neurol Neurosurg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  804-9     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery and Gamma Knife, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Angiography, Digital Subtraction
Cerebral Angiography
Cerebral Hemorrhage / etiology*,  surgery*
Child
Female
Humans
Intracranial Arteriovenous Malformations / complications*,  surgery*
Magnetic Resonance Imaging
Male
Middle Aged
Radiometry
Radiosurgery*
Survival Analysis
Tomography, X-Ray Computed
Treatment Outcome

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


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