Document Detail


Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than 5 years after irradiation.
MedLine Citation:
PMID:  8727815     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The detailed long-term follow-up results of 40 patients treated for cerebral arteriovenous malformations with gamma knife radiosurgery are presented, with special reference to postradiosurgical complications that can develop many years after irradiation. The follow-up period after radiosurgery was 54 to 205 months, excluding one mortality, with a mean and a median of 106 and 97 months, respectively. One patient (2.5%) has, to date, refused all neuroimaging follow-up examinations. Complete nidus obliteration was angiographically confirmed in 26 patients (65%) between 1 and 5 years after radiosurgery. In the remaining 13 patients (32.5%), although significant shrinkage of each nidus was angiographically demonstrated, complete obliteration was not attained during a 3- to 7-year period of follow-up after radiosurgery. Among these 13 patients, 1 underwent surgical extirpation of the nidus and 5 underwent second courses of gamma knife radiosurgery between 3 and 6 years after initial treatment; in 3 of the 5 patients, complete nidus obliteration was angiographically confirmed between 1 and 3 years after the second course of radiosurgery. There were no radiation- or arteriovenous malformation-related mortalities. However, we did experience one angiography-related mortality. We also experienced one morbidity (probably caused by hemorrhagic stroke), which developed 5 years after 2-year postradiosurgical angiography had demonstrated complete obliteration, and three radiation-related morbidities, two of which (hemiparkinsonian syndrome and visual field disturbances caused by delayed cyst formation) occurred 5.5 and 7 years, respectively, after irradiation. Furthermore, we observed another two patients who, although asymptomatic to date, showed delayed cyst formation on magnetic resonance imaging 5 and 10 years after irradiation, respectively. In total, 3 (23%) of 13 patients who underwent computed tomography and/or magnetic resonance imaging more than 5 years after radiosurgery showed delayed cyst formation. In conclusion, long-term follow-up, particularly with the use of neuroimaging techniques, is necessary even after the treatment goal has been achieved.
Authors:
M Yamamoto; M Jimbo; M Hara; I Saito; K Mori
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurosurgery     Volume:  38     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  1996 May 
Date Detail:
Created Date:  1996-10-31     Completed Date:  1996-10-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  906-14     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Tokyo Women's Medical College Dai-ni Hospital, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Brain / radiation effects
Cerebral Angiography
Cerebral Hemorrhage / diagnosis,  etiology,  surgery
Cerebrovascular Disorders / diagnosis,  etiology,  surgery
Child
Cysts / diagnosis,  etiology,  surgery
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / diagnosis,  surgery*
Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Complications / diagnosis,  etiology*,  surgery
Radiation Injuries / diagnosis,  etiology,  surgery
Radiosurgery*
Reoperation
Tomography, X-Ray Computed

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