Document Detail

Embolization before radiosurgery reduces the obliteration rate of arteriovenous malformations.
MedLine Citation:
PMID:  17327788     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the arteriovenous malformation (AVM) obliteration rate and the clinical outcome after radiosurgery in patients with and without previous embolization. METHODS: Of 244 patients who underwent linear accelerator radiosurgery for AVMs at the Sunnybrook Health Sciences Centre between 1989 and 2000, 61 patients had embolization before radiosurgery and complete follow-up for at least 3 years. For 47 of these 61 patients (Group A, embolization plus radiosurgery), we were able to find 47 matching patients without previous embolization (Group B, radiosurgery alone). This group of matching patients had the same AVM volume (after embolization in Group A), location, and marginal dose. The radiosurgery-based AVM score and the obliteration prediction index were calculated. RESULTS: The median follow-up period was 44 months. Nidus obliteration was achieved in 22 patients in Group A (47%) and 33 patients in Group B (70%, P = 0.036). Permanent deficit related to hemorrhage or radiation occurred in three patients (6%) in Group A and three patients (6%) in Group B. During the first 3 years after radiosurgery, two patients (4%) in Group A experienced hemorrhage; in Group B, five patients (11%) experienced hemorrhage (P = 0.2). In Group B, two patients (4%) died and two patients (4%) had their AVM surgically removed. Both deaths were related to hemorrhage during the latency period. The excellent outcome (obliteration plus no deficit) in Group A was 47% compared with 64% in Group B (P = 0.146). There was no difference in the obliteration prediction index and the radiosurgery-based AVM score between Groups A and B. The predicted rates of obliteration and excellent outcome were 55 and 62.5%, respectively, according to the obliteration prediction index and the radiosurgery-based AVM score. CONCLUSION: Embolization before radiosurgery significantly decreases the obliteration rate, even in AVMs with the same volume, location, and marginal dose. Although an excellent outcome rate was higher in the group without embolization, this was not statistically significant.
Yuri M Andrade-Souza; Meera Ramani; Daryl Scora; May N Tsao; Karel terBrugge; Michael L Schwartz
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  60     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-28     Completed Date:  2007-03-19     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  443-51; discussion 451-2     Citation Subset:  IM    
Division of Neurosurgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto Western Hospital, Toronto, Canada.
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MeSH Terms
Combined Modality Therapy / statistics & numerical data
Embolization, Therapeutic / statistics & numerical data*
Intracranial Arteriovenous Malformations / mortality*,  pathology,  therapy*
Ontario / epidemiology
Preoperative Care / methods,  statistics & numerical data*
Radiosurgery / statistics & numerical data*
Survival Rate
Treatment Outcome

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

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