| Gamma knife surgery for brainstem arteriovenous malformations. | |
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MedLine Citation:
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PMID: 21839958 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate the long-term imaging and clinical outcomes of patients with brainstem arteriovenous malformations (AVMs) treated with Gamma Knife surgery (GKS). METHODS: The study included 85 patients with brainstem AVMs undergoing GKS during the period 1989-2007. The locations of the nidi were the midbrain in 42 patients, pons in 31 patients, and medulla oblongata in 12 patients. The volume of the nidi ranged from 0.1-8.9 mL (median 1.4 mL, mean 1.9 mL), and the prescription dose ranged from 5-32 Gy (median 20 Gy, mean 19.9 Gy). After the initial Gamma procedure, 18 patients had repeat GKS for AVM residuals that were still patent. Two patients had a third GKS 7 years and 16 years after a failed repeat GKS. Clinical follow-up ranged from 24-252 months with a mean of 100 months (median 102 months) after the initial GKS. RESULTS: GKS yielded a total angiographic obliteration in 50 (58.8%) patients and subtotal obliteration in 4 (4.7%) patients. In 22 (25.9%) patients, the AVMs remained patent. In 9 patients (10.6%), no flow voids were observed on magnetic resonance imaging (MRI), but angiographic confirmation was unavailable. A small nidus volume and a high prescription dose were significantly associated with increased AVM obliteration rate. Radiation-induced changes developed in 34 patients (40%); 24 were asymptomatic, 1 patient had only headache, and 9 patients developed neurologic deficits. One patient developed a large cyst 6 years after GKS. CONCLUSIONS: Given the poor surgical outcome of brainstem AVMs, the results of 59% nidus obliteration and 6% permanent neurologic deficits make GKS a reasonable management of these difficult lesions. |
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Authors:
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Chun-Po Yen; Ladislau Steiner |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: World neurosurgery Volume: 76 ISSN: 1878-8750 ISO Abbreviation: World Neurosurg Publication Date: 2011 Jul-Aug |
Date Detail:
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Created Date: 2011-08-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101528275 Medline TA: World Neurosurg Country: United States |
Other Details:
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Languages: eng Pagination: 87-95 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Elsevier Inc. All rights reserved. |
Affiliation:
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Lars Leksell Center for Gamma Surgery, Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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