Document Detail


Gamma knife radiosurgery for arteriovenous malformations of basal ganglia, thalamus and brainstem--a retrospective study comparing the results with that for AVMs at other intracranial locations.
MedLine Citation:
PMID:  19415175     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The objective of this retrospective study was to study the outcome in patients with basal ganglia, thalamus and brainstem (central/deep) arteriovenous malformations (AVMs) treated with gamma knife radiosurgery (GKS) and to compare the results with that for AVMs at other intracranial locations.
METHODS AND RESULTS: The results of 53 patients with central AVMs and 255 patients with AVMs at other locations treated with GKS at our center between April 1997 and March 2005 with minimum follow-up of 1 year were analyzed. CENTRAL AVMS: Forty of these 53 AVMs were Spetzler-Martin grade III, 11 were grade IV, and 2 were grade V. The mean AVM volume was 4.3 cm(3) (range 0.1-36.6 cm(3)). The mean marginal dose given was 23.3 Gy (range 16-25 Gy). The mean follow-up was 28 months (range 12-96 months). Check angiograms were advised at 2 years after GKS and yearly thereafter in the presence of residual AVM till 4 years. Presence of a residual AVM on an angiogram at 4 years after radiosurgery was considered as radiosurgical failure. Complete obliteration of the AVM was documented in 14 (74%) of the 19 patients with complete angiographic follow-up. Significantly lower obliteration rates (37% vs. 100%) were seen in larger AVMs (>3 cm(3)) and AVMs of higher (IV and V) Spetzler-Martin grades (28% vs. 100%). The 3- and 4-year actuarial rates of nidus obliteration were 68% and 74%, respectively. Eight patients (15%) developed radiation edema with a statistically significantly higher incidence in patients with AVM volume >3 cm(3) and in patients with Spetzler-Martin grade IV and V AVMs. Five patients (9.4%) had hemorrhage in the period of latency. COMPARISON OF RESULTS WITH AVMS AT OTHER LOCATIONS: Patients with central AVMs presented at a younger age (mean age 22.7 years vs. 29 years), with a very high proportion (81% vs. 63%) presenting with hemorrhage. Significantly higher incidence of radiation edema (15% vs. 5%) and lower obliteration rates (74% vs. 93%) were seen in patients with central AVMs.
CONCLUSIONS: GKS is an effective modality of treatment for central AVMs, though relatively lower obliteration rates and higher complication rates are seen compared to AVMs at other locations.
Authors:
Narayanam Anantha Sai Kiran; Shashank Sharad Kale; Manish Kumar Kasliwal; Sandeep Vaishya; Aditya Gupta; Manish Singh Sharma; Bhawani Shankar Sharma; Ashok Kumar Mahapatra
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-05-05
Journal Detail:
Title:  Acta neurochirurgica     Volume:  151     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2010-06-14     Completed Date:  2011-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  1575-82     Citation Subset:  IM    
Affiliation:
Department of Neuro Surgery, Neuro Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Basal Ganglia / pathology,  surgery*
Brain Stem / pathology,  surgery*
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / pathology,  radiography,  surgery*
Male
Middle Aged
Outcome Assessment (Health Care) / methods
Radiation Dosage
Radiosurgery / methods,  statistics & numerical data*
Retrospective Studies
Thalamus / pathology,  surgery*
Treatment Outcome
Young Adult

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


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